【摘要】：背景:低水平白蛋白尿(LGA)(30 mg/g)被認(rèn)為和心血管疾病風(fēng)險(xiǎn)的增高相關(guān)。我們旨在研究2型糖尿病患者中,正常尿白蛋白肌酐比值(UACR)和左室舒張功能及左室重構(gòu)的關(guān)系。方法:888例2010年6月至2014年9月就診于福建醫(yī)科大學(xué)附屬第一醫(yī)院內(nèi)分泌科UACR正常(30 mg/g)的2型糖尿病患者(465名男性和423名女性)參與了這項(xiàng)回顧性研究。依據(jù)UACR分為四組(0.90-5.87,5.87-9.17,9.17-15.30,15.30-30.00mg/g)。通過心臟彩超測得計(jì)算舒張?jiān)缙诙獍昕谒俣?E),平均舒張?jiān)缙诙獍戥h(huán)速度(平均e),左室重量指數(shù)(LVMI),相對室壁厚度(RWT)。左室舒張功能通過E/e和平均e評估,左室重構(gòu)通過體表面積標(biāo)準(zhǔn)化的左室質(zhì)量(LVMI)和相對室壁厚度(RWT)評估。結(jié)果:1.不同UACR水平的2型糖尿病患者出現(xiàn)亞臨床左室舒張功能障礙的頻率為Q1(42.3%)Q2(52.7%)Q3(56.8%)Q4(65.3%)(P0.001),出現(xiàn)左室重構(gòu)的頻率為Q1(17.6%)Q2(27.0%)Q3(30.6%)Q4(35.1%)(P0.001),不同UACR水平的2型糖尿病患者出現(xiàn)亞臨床左室舒張功能障礙及左室重構(gòu)頻率隨著UACR分組均有升高的趨勢。2.在調(diào)整年齡、性別、糖尿病病程、收縮壓、舒張壓、eGFR、Hb A1c、BMI后,UACR和平均e,E/e,LVMI顯著相關(guān)(β=-0.004,p0.001;β=0.081,p0.001;β=0.383,p0.001),和RWT不相關(guān)。3.在logistic回歸分析中,調(diào)整年齡、性別、糖尿病病程、收縮壓、舒張壓、e GFR、Hb A1c、BMI、吸煙史、飲酒史及用藥史后,最高四分位組的病人患左室舒張功能障礙的風(fēng)險(xiǎn)可能是最低四分位組的病人的1.625倍(OR=1.625,95%CI=1.029-2.568,P=0.037),而第三及第四組的病人左室重構(gòu)風(fēng)險(xiǎn)分別是最低組的病人的1.729倍及1.994倍(OR=1.729,95%CI=1.064-2.810,P=0.027;OR=1.994,95%CI=1.232-3.227,P=0.005)。4.UACR和亞臨床心臟舒張功能障礙的關(guān)系在小于60歲,病程短于10年,非肥胖或未合并高血壓病的女性患者中仍存在。UACR和左室重構(gòu)的聯(lián)系在非肥胖、年長、低密度脂蛋白膽固醇正常水平、病程短于10年、無高血壓病的男性患者中仍然存在。結(jié)論:2型糖尿病患者中,正常高水平UACR和亞臨床左室舒張功能障礙及左室重構(gòu)相關(guān)。LGA和心血管疾病風(fēng)險(xiǎn)相關(guān),可能是2型糖尿病患者亞臨床心血管損傷的標(biāo)志。
[Abstract]:Background: low-level albuminuria (LGA) (30 mg/g) is associated with increased risk of cardiovascular disease. We investigated the relationship between (UACR), left ventricular diastolic function and left ventricular remodeling in patients with type 2 diabetes. Methods from June 2010 to September 2014, a total of 888 type 2 diabetic patients (465 males and 423 females) with normal UACR (30 mg/g) from the Department of Endocrinology, first affiliated Hospital of Fujian Medical University, participated in the retrospective study. According to UACR, they were divided into four groups (0.90-5.87, 5.87-9.17, 9.17-15.30, 15.30-30.00mg / g). Calculation of early diastolic mitral orifice velocity by color Doppler echocardiography (E), mean early diastolic mitral annular velocity (mean e), left ventricular mass index (LVMI), relative wall thickness (RWT).) Left ventricular diastolic function was evaluated by E / e and mean e, and left ventricular remodeling was assessed by (LVMI) and relative wall thickness (RWT). The result is 1: 1. The frequency of subclinical left ventricular diastolic dysfunction in type 2 diabetic patients with different UACR levels was Q1 (42.3%), Q2 (52.7%), Q3 (56.8%), Q4 (65.3%) (P0.001), Q1 (17.6%), Q2 (27.0%), Q3 (30.6%) (P0.001), subclinical left ventricular diastolic dysfunction and left ventricular diastolic dysfunction (P0.001) in patients with type 2 diabetes with different UACR levels. The frequency of ventricular remodeling increased with the grouping of UACR. After adjusting for age, sex, course of diabetes, systolic blood pressure, diastolic blood pressure (DBP), RWT was not correlated with mean ER (尾 -0.004, p0.001; 尾, 0.081, p0.001; 尾, 0.383p0.001), and was not correlated with RWT. In logistic regression analysis, age, sex, course of diabetes, systolic blood pressure, diastolic blood pressure, smoking history, drinking history and drug use history were adjusted. The risk of left ventricular diastolic dysfunction in the highest quartile group was 1.625 times higher than that in the lowest quartile group (OR=1.625,95%CI=1.029-2.568,P=0.037), while the risk of left ventricular remodeling in the third and fourth groups was 1.729 and 1.994 times higher than that in the lowest group, respectively (OR=1.729,95%CI=1.064-2.810,P=0.027;OR=1.994,95%CI=1.232-3.227,P=0.005. The relationship between subclinical cardiac diastolic dysfunction and subclinical diastolic dysfunction is less than 60 years old. The course of disease was less than 10 years, and the relationship between .UACR and left ventricular remodeling was found in non-obese women or women without hypertension in normal levels of non-obese, elderly, low-density lipoprotein cholesterol, and the course of disease was shorter than 10 years. Male patients without hypertension are still present. Conclusion in patients with type 2 diabetes mellitus, normal high level of UACR is associated with subclinical left ventricular diastolic dysfunction, left ventricular remodeling and cardiovascular disease risk, which may be a marker of subclinical cardiovascular injury in type 2 diabetes mellitus.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1

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