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目的:对比观察糖调节受损(IGR)患者左心室舒张功能(左室顺应性),为糖尿病Ⅱ级预防提供参考。对象:IGR又称糖尿病前期,按照WHO1999年的糖调节受损诊断标准,统计本中心5年内检出的空腹血糖受损(IFG)和糖耐量减低(IGT)及糖化血红蛋白增高的患者,排除冠心病、高血压病,共128(男80例,女48)例,年龄35～62(48.41±6.82)岁,另外选择相似年龄段的血糖及糖化血红蛋白正常的120例作为对照组,年龄33～60(47.06±6.41)岁。方法:应用多普勒超声心动图,记录舒张期二尖瓣口血流频谱形态,测量舒张早期血流速度(E)、舒张晚期血流速度(A)、E峰减速时间(DT)。以E/A比值、E峰减速时间作为左心室舒张功能(顺应性)参考指标,测量3个心动周期取平均值。IGR组与血糖正常组对照,组间显著性检验用t检验。结果:IGR组E/A比值为1.14±0.32,E峰减速时间为(239.30±32.31)ms;血糖正常组E/A比值为1.43±0.36,E峰减速时间为(228.92±26.89)ms。两组间两项指标都有显著性差异,(分别为t=6.74,P<0.05;t=2.73,P<0.05)。结论:高血糖可导致心脏微血管变化,心肌代谢紊乱,抗氧化防御能力降低,心肌细胞间质纤维化等,最终导致心功能下降,早期以舒张功能下降为主。多普勒超声技术,可以在健康体检中早期发现心脏舒张功能下降。以上观察显示,糖尿病前期已经开始出现左室顺应性下降,提示我们糖尿病的Ⅱ级预防要从糖尿病前期开始,早期干预有利于预防糖尿病性心血管病。
Objective: To compare left ventricular diastolic function (left ventricular compliance) in patients with impaired glucose regulation (IGR) and provide a reference for prevention of grade Ⅱ diabetes. PARTICIPANTS: IGR is also called pre-diabetes. According to the WHO diagnostic criteria for the failure-to-deliver status in 1999, statistics of IFG, IGT and HbA1c detected within 5 years of this center were excluded. A total of 128 patients (80 males and 48 females) aged 35-62 years old (48.41 ± 6.82 years), and another 120 normal subjects with similar blood glucose and glycosylated hemoglobin as the control group, aged 33 ~ 60 (47.06 ± 6.41) years old. Methods: Doppler echocardiography was used to record the spectral shape of diastolic mitral flow. The early diastolic flow velocity (E), the late diastolic flow velocity (A) and the E peak decelerating time (DT) were measured. E / A ratio, E peak deceleration time as a reference function of left ventricular diastolic function (compliance), measure the average of 3 cardiac cycles. IGR group and normal control group, the significance test between groups using t test. Results: The E / A ratio of IGR group was 1.14 ± 0.32 and the peak decelerating time of E group was (239.30 ± 32.31) ms. The E / A ratio of normal glucose group was 1.43 ± 0.36 and the peak decelerating time of E group was (228.92 ± 26.89) ms. There was a significant difference between the two groups in the two measures (t = 6.74, P <0.05; t = 2.73, P <0.05). CONCLUSION: Hyperglycemia can lead to changes of cardiac microvascular, disturbance of myocardial metabolism, decrease of antioxidant defenses and interstitial fibrosis of cardiomyocytes, which lead to decrease of cardiac function and decrease of diastolic function in the early stage. Doppler ultrasound technology, early detection of decreased cardiac diastolic function in physical examination. The above observations show that pre-diabetes has begun to appear decreased left ventricular compliance, suggesting that our class Ⅱ prevention of diabetes should start from the pre-diabetes, early intervention is conducive to the prevention of diabetic cardiovascular disease.