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目的探讨不同血糖控制水平对2型糖尿病患者左室结构和功能的影响。方法选择2009年9月~2011年1月于巴中市中心医院就诊的2型糖尿病患者40例作为糖尿病组,另选择性别年龄匹配的健康志愿者40例为正常对照组。对糖尿病组患者进行规范化治疗,观察期24个月,比较治疗前后患者左室结构和功能的超声学参数。随访末,根据血糖控制水平将糖尿病组分为良好组(Hb A1c<7.6%,n=17)、中等组(7.6%≤Hb A1c≤9%,n=14)和不良组(Hb A1c>9%,n=9)3个亚组,比较随访前后3组的超声学参数的变化。结果在基线水平糖尿病等容舒张期时间(IVRT)糖尿病组明显高于对照组(P<0.05),E/A低于对照组(P<0.05),两组在室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室舒张末内径(LVEDD)及左室收缩功能等方面差异无统计学意义;随访前后,血糖控制良好组左室结构和功能超声参数差异无统计学意义;中等组和不良组不同程度地出现IVS、LVPW及左室质量指数(LVMI)增加,IVRT延长和E/A降低,差异均有统计学意义(P<0.05)。结论 2型糖尿病患者容易发生左室舒张功能减退,积极控制血糖可以延缓左室肥厚的发生,但不能改善左室舒张功能,血糖控制不良会加速左室重构和加重左室舒张功能不全。
Objective To investigate the effects of different blood glucose levels on left ventricular structure and function in type 2 diabetic patients. Methods From September 2009 to January 2011, 40 patients with type 2 diabetes who were treated in Bazhong Central Hospital were enrolled as diabetic group. Another 40 healthy volunteers were selected as normal control group. Diabetic patients were standardized treatment, observation period of 24 months, compared before and after treatment of patients with left ventricular structural and functional ultrasound parameters. At the end of the follow-up period, the diabetic patients were divided into two groups according to the level of glycemic control: diabetes group (Hb A1c <7.6%, n = 17), moderate group (7.6% ≤Hb A1c≤9%, n = 14) %, n = 9) 3 subgroups. The changes of ultrasound parameters in 3 groups before and after follow-up were compared. Results In the baseline diastolic time (IVRT) diastolic time (IVRT), the diabetic group was significantly higher than the control group (P <0.05), and the E / A was lower than the control group (P <0.05) LVPW, LVEDD and left ventricular systolic function had no statistical significance. Before and after follow-up, there was no significant difference in left ventricular structure and functional ultrasound parameters between the two groups The levels of IVS, LVPW, LVMI, IVRT prolongation and E / A decreased in both groups and poor groups, with statistical significance (P <0.05). Conclusions Patients with type 2 diabetes are prone to have left ventricular diastolic dysfunction. Positive control of blood glucose can delay left ventricular hypertrophy, but can not improve left ventricular diastolic function. Poor control of blood glucose will accelerate left ventricular remodeling and aggravate left ventricular diastolic dysfunction.