老年2型糖尿病肾病患者心功能改变及影响因素分析

Analysis of cardiac function changes and its influencing factors in elderly patients with type 2 diabetic nephropathy

中文关键词: 老年  糖尿病肾病  白蛋白尿  左室收缩功能不全

英文关键词: elderly  diabetic nephropathy  albuminuria  left ventricular systolic dysfunction

中文摘要:

      目的 本研究采用二维斑点追踪应变超声心动图(2D-STE)研究老年2 型糖尿病患者心脏功能改变并探索其相关危险因素.方法 选取2022 年3 月—2023 年3 月经复旦大学附属华东医院确诊的老年 2 型糖尿病肾病(DN)患者44 例、单纯2 型糖尿病(DM)患者56 例以及老年健康对照20 例,收集其临床资料,进行常规超声心动图和 2D-STE检查,比较各组间指标差异.采用多因素Logistic回归法分析患者发生亚临床左室收缩功能不全(GLS＜18%)的危险因素.结果 2D-STE结果显示,老年DN患者E/e'和舒张功能不全(E/e'＞14)发生比例较健康对照组或DM组均有显著增加;与健康对照组或DM组比较,DN组左室整体纵向应变值(GLS)明显下降,亚临床左室收缩功能不全发生比例显著增加,差异有统计学意义.Logistic回归分析显示,蛋白尿、eGFR＜60 mL/min/1.73 m2 和总胆固醇是老年2 型糖尿病患者发生亚临床左室收缩功能不全的危险因素.结论 老年DN患者存在舒张功能障碍和GLS评估的亚临床左室收缩功能减退.蛋白尿、eGFR＜60 mL/min/1.73 m2 和总胆固醇与老年 2 型糖尿病患者左室收缩期纵向心肌功能障碍密切相关.

英文摘要:

      Objective To investigate the early changes of cardiac function and related risk factors in elderly patients with type 2 diabetes mellitus(DM)by two-dimensional spot tracking strain echocardiography(2D-STE).Methods From March 2022 to March 2023,44 elderly patients with type 2 diabetic nephropathy(DN),56 DM patients and 20 elderly healthy controls were selected from Huadong Hospital Affiliated to Fudan University.Their clinical data were collected and routine ech-ocardiography and 2D-STE were performed.The index differences were compared among the three groups.Multivariate logistic regression was used to analyze the risk factors for subclinical left ventricular systolic dysfunction(GLS＜18%)in patients.Results The 2D-STE results showed that the E/e'value and the proportion of diastolic dysfunction(E/e'＞14)in the DN group were significantly higher than those in the healthy control group or the DM group.Compared with the healthy control group or DM group,the global longitudinal strain(GLS)value of left ventricle of the DN group decreased significantly,and the incidence of subclinical left ventricular systolic dysfunction increased significantly,with statistical significance.Logistic re-gression analysisshowed that albuminuria,eGFR＜60 mL/min/1.73 m2 and total cholesterol were risk factors for subclinical left ventricular systolic dysfunction in elderly DM patients.Conclusion Elderly DN patients have diastolic dysfunction and subclinical left ventricular systolic dysfunctionassessedby GLS.Albuminuria,GFR＜60 mL/min/1.73 m2 andtotalcholester-ol are closely related to left ventricular systolic longitudinal myocardial dysfunction in elderly DM patients.