【摘要】 目的 探討2型糖尿病（T2DM）胰島素抵抗導(dǎo)致糖尿病性心功能不全的臨床表現(xiàn)特點及相關(guān)激素的改變。 方法 2008年1-4月對T2DM患者35例（胰島素抵抗指數(shù)HOMA-IR lt;2.69者19例為A1組，HOMA-IR≥2.69者16例為A2組）及健康體檢者20人B組測體重指數(shù)（BMI）、空腹血糖（FPG）、胰島素、心鈉素（ANP）、腦鈉素（BNP）水平；心臟彩色多普勒超聲分別測E/A、e/a、S/D、LVEF、DT期。 結(jié)果 A2組BMI較A1、B組均明顯增加（P lt;0.05），A1、B組間差異無統(tǒng)計學(xué)意義（P gt;0.05）。ANP、BNP及DT值在A1、A2組均較B組增高（P lt;0.05），BNP在A2組高于A1組（P lt;0.05），ANP、DT值在A1、A2組間差異均無統(tǒng)計學(xué)意義（P gt;0.05）。E/A、e/a和S/D在A1、A2組均較B組降低（P lt;0.05），A1、A2組間差異均無統(tǒng)計學(xué)意義（P gt;0.05）。A2組患者LVEF較A1、B組均明顯降低（P lt;0.05），A1、B組間差異無統(tǒng)計學(xué)意義（P gt;0.05）。 結(jié)論 隨著胰島素抵抗加重，心肌舒張順應(yīng)性較差和收縮力下降，伴隨相關(guān)激素（心臟利鈉肽）分泌增加，最終產(chǎn)生心功能不全的臨床表現(xiàn)、體征及多普勒超聲心動圖表現(xiàn)。
【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IR lt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (P lt;0.05), while the difference between the later two groups was not statistically significant (P gt;0.05). The ANP, BNP and DT stage were all higher than those in group B (P lt;0.05), the BNP was higher in group A2 than in group A1 (P lt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (P gt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (P lt;0.05), while there were no statistically significant diferences between group A1 and A2 (P gt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (P lt;0.05), and the values in group A2 were the lowest (P lt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.
引用本文： 周廣朋,張敏,董巍,賈曉利,周曉芳,陳樹. 2型糖尿病胰島素抵抗與糖尿病性心功能不全的觀察. 華西醫(yī)學(xué), 2011, 26(1): 44-46. doi: 復(fù)制
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- 1. Bell DSH. Heart failure: a serious and common comorbidity of diabetes[J]. Clinical Diabetes, 2004, 22(2): 61-65.
- 2. Nielson C, Lange T. Blood glucose and heart failure in nondiabetic patients[J]. Diabetes Care, 2005, 28(3): 607-611.
- 3. Witteles RM, Fowler MB. Insulin-resistant cardiomypathy clinical evidence, mechanisms, and treatment options[J]. J Am Coll Cardiol, 2008, 51(2): 93-102.
- 4. 包哈申, 柳景華, 劉宇揚, 等. 胰島素抵抗與心力衰竭[J]. 心肺血管病雜志, 2010, 29(3): 259-261.
- 5. Wallace TM, Matthews DR. The assessment of insuin resistance in man[J]. Diabet Med, 2002,19(7): 527-534.
- 6. 李秀鈞. 胰島素抵抗綜合癥[M]. 2版. 北京: 人民衛(wèi)生出版社, 2007: 3.
- 7. Ford ES, Giles WH. A comparison of the prevalence of the metabolic syndrome using two proposed definitions[J]. Diabetes Care, 2003, 26(2): 575-581.
- 8. 刑小燕, 楊文英, 楊兆軍, 等. 胰島素抵抗指數(shù)在不同糖耐量人群中診斷代謝綜合征的作用[J]. 中華糖尿病雜志, 2004, 12(3): 182-186.
- 9. Regan TJ, Lyons MM, Ahmed SS, et al. Evidence for cardiomyopathy in familial diabetes mellitus[J]. J Clin Invest, 1997, 60(5): 885-887.
- 10. Longnus SL, Wambolt RB, Ban RI, et al. Regulation of myocardial fatty acid oxidation by sustrate supply[J]. Am J Physiol Heart Circ Physiol, 2001, 281(4): H1561-H1567.
- 11. Kelly D. Whrtworth JA. Endothelin-1 as a mediator in cardiovascular disease[J]. Clin Exp Pharmacol Physiol, 1999, 26(2): 158-161.
- 12. 許朝祥, 杜心清, 許有容, 等. 胰島素抵抗與充血性性心力衰竭[J]. 心血管病學(xué)進展, 2001, 22(6): 334-337.
- 13. 殷麗瓊, 吳繼雄. 胰島素抵抗與高血壓病左室肥厚、心力衰竭的關(guān)系[J]. 安徽醫(yī)科大學(xué)學(xué)報, 2005, 40(2): 173-175.
- 14. Fredersdorf S, Thumann C, Ulucan C, et al. Myocardial hypertrophy and enhanced left ventricular contractility in Zucker diabetic fatty rats[J]. Cardiovasc Pathol, 2004, 13(1): 11-19.