Karpov R S, Koshel'skaia O A
Ter Arkh. 2007;79(1):32-8.
To study specific features of left ventricular remodeling (LVR) in patients with hypertension and diabetes mellitus type 2 (DM-2).
The study group comprised 290 patients, the control group consisted of 79 patients with essential hypertension free of carbohydrate tolerance impairment. The age of the examinees ranged from 35 to 60 years. Structural-geometric left ventricular model was determined by echocardiography. Estimation of significant determinants of myocardial mass index (MMI) and types of left ventricular remodeling was made with multiple regression analysis and logistic regression. The parameters of 24-h monitoring of blood pressure, glycemic control, blood lipid-transport function, plasma insulin, aldosteron, hydrocortisone levels, blood rennin activity were used as independent variants. Incidence of registration of left ventricular excentric hypertrophy (LVEH) in the study group was higher as compared to control (27.6 and 16.5%, respectively; p < 0.05). A rise of left ventricular MMI in the study group was related to 24-h systolic arterial pressure and basal insulinemia (R2 = 0.4229). Development of left ventricular structural-geometric model in the study group depended on the gender, duration of diabetes, 24-h systolic blood pressure (direct correlation) and 24-h diastolic blood pressure (inverse correlation), R2 = 0.6500. In DM duration about 5 years, percentage of males with concentric left ventricular hypertrophy (CLVH) and LVEH was 63% versus 37% (chi-square 5.0815, p < 0.03). In longer diabetes LVEH was seen more frequently than CLVH (73.3 and 26.7%, respectively). Among women with left ventricular hypertrophy and hypertension under 10 years LVEH and CLVH were detected in 69.1 and 30.9% cases, respectively (chi-square 7.9356, p < 0.01). Later, these differences became less obvious (41.7 and 58.3%, respectively).
Hypertensive patients with diabetes mellitus type 2 develop structural-geometric changes of the heart earlier. LVR in such patients is associated with gender, duration of DM and non-proportional growth of 24-h systolic blood pressure leading to gender-related differences in the time of formation of LVEH and CLVH.
研究高血压合并2型糖尿病（DM-2）患者左心室重构（LVR）的特点。
研究组包括290例患者，对照组由79例无糖耐量受损的原发性高血压患者组成。受检者年龄在35至60岁之间。通过超声心动图确定左心室结构几何模型。采用多元回归分析和逻辑回归评估心肌质量指数（MMI）的重要决定因素及左心室重构类型。将24小时血压监测、血糖控制、血脂转运功能、血浆胰岛素、醛固酮、氢化可的松水平、血肾素活性等参数作为独立变量。研究组左心室离心性肥厚（LVEH）的登记发生率高于对照组（分别为27.6%和16.5%；p<0.05）。研究组左心室MMI升高与24小时收缩压和基础胰岛素血症有关（R2=0.4229）。研究组左心室结构几何模型的形成取决于性别、糖尿病病程、24小时收缩压（正相关）和24小时舒张压（负相关），R2=0.6500。在糖尿病病程约5年时，男性同心性左心室肥厚（CLVH）和LVEH的比例分别为63%和37%（卡方值5.0815，p<0.03）。糖尿病病程较长时，LVEH比CLVH更常见（分别为73.3%和26.7%）。在左心室肥厚合并高血压病程不足10年的女性中，LVEH和CLVH的检出率分别为69.1%和30.9%（卡方值7.9356，p<0.01）。之后，这些差异变得不那么明显（分别为41.7%和58.3%）。
2型糖尿病高血压患者心脏结构几何改变出现较早。此类患者的LVR与性别、糖尿病病程以及24小时收缩压的非比例增长有关，导致LVEH和CLVH形成时间存在性别差异。
