【摘要】 目的 探讨2型糖尿病（T2DM）胰岛素抵抗导致糖尿病性心功能不全的临床表现特点及相关激素的改变。 方法 2008年1-4月对T2DM患者35例（胰岛素抵抗指数HOMA-IR lt;2.69者19例为A1组，HOMA-IR≥2.69者16例为A2组）及健康体检者20人B组测体重指数（BMI）、空腹血糖（FPG）、胰岛素、心钠素（ANP）、脑钠素（BNP）水平；心脏彩色多普勒超声分别测E/A、e/a、S/D、LVEF、DT期。 结果 A2组BMI较A1、B组均明显增加（P lt;0.05），A1、B组间差异无统计学意义（P gt;0.05）。ANP、BNP及DT值在A1、A2组均较B组增高（P lt;0.05），BNP在A2组高于A1组（P lt;0.05），ANP、DT值在A1、A2组间差异均无统计学意义（P gt;0.05）。E/A、e/a和S/D在A1、A2组均较B组降低（P lt;0.05），A1、A2组间差异均无统计学意义（P gt;0.05）。A2组患者LVEF较A1、B组均明显降低（P lt;0.05），A1、B组间差异无统计学意义（P gt;0.05）。 结论 随着胰岛素抵抗加重，心肌舒张顺应性较差和收缩力下降，伴随相关激素（心脏利钠肽）分泌增加，最终产生心功能不全的临床表现、体征及多普勒超声心动图表现。
【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.
Citation：
ZHOU Guangpeng,ZHANG Min,DONG Wei,JIA Xiaoli,ZHOU Xiaofang,CHEN Shu. Clinical Observation of Insulin Resistance and Diabetic Cardiac Insufficiency in Type 2 Diabetes Mellitus. West China Medical Journal, 2011, 26(1): 44-46. doi:
Copy
Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
| 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, 柳景华, 刘宇扬, 等. 胰岛素抵抗与心力衰竭[J]. 心肺血管病杂志, 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. |
李秀钧. 胰岛素抵抗综合症[M]. 2版. 北京: 人民卫生出版社, 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, 杨文英, 杨兆军, 等. 胰岛素抵抗指数在不同糖耐量人群中诊断代谢综合征的作用[J]. 中华糖尿病杂志, 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. |
许朝祥, 杜心清, 许有容, 等. 胰岛素抵抗与充血性性心力衰竭[J]. 心血管病学进展, 2001, 22(6): 334-337.
|
| 13. |
殷丽琼, 吴继雄. 胰岛素抵抗与高血压病左室肥厚、心力衰竭的关系[J]. 安徽医科大学学报, 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.
|
- 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, 柳景华, 刘宇扬, 等. 胰岛素抵抗与心力衰竭[J]. 心肺血管病杂志, 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. 李秀钧. 胰岛素抵抗综合症[M]. 2版. 北京: 人民卫生出版社, 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, 杨文英, 杨兆军, 等. 胰岛素抵抗指数在不同糖耐量人群中诊断代谢综合征的作用[J]. 中华糖尿病杂志, 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. 许朝祥, 杜心清, 许有容, 等. 胰岛素抵抗与充血性性心力衰竭[J]. 心血管病学进展, 2001, 22(6): 334-337.
- 13. 殷丽琼, 吴继雄. 胰岛素抵抗与高血压病左室肥厚、心力衰竭的关系[J]. 安徽医科大学学报, 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.
