Department of Internal Medicine/Pediatrics, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
Pulm Circ. 2015 Mar;5(1):117-23. doi: 10.1086/679705.
Diabetes complicates management in a number of disease states and adversely impacts survival; how diabetes affects patients with pulmonary hypertension (PH) has not been well characterized. With insulin resistance having recently been demonstrated in PH, we sought to examine the impact of diabetes in these patients. Demographic characteristics, echo data, and invasive hemodynamic data were prospectively collected for 261 patients with PH referred for initial hemodynamic assessment. Diabetes was defined as documented insulin resistance or treatment with antidiabetic medications. Fifty-five patients (21%) had diabetes, and compared with nondiabetic patients, they were older (mean years ± SD, 61 ± 13 vs. 56 ± 16; [Formula: see text]), more likely to be black (29% vs. 14%; [Formula: see text]) and hypertensive (71% vs. 30%; [Formula: see text]), and had higher mean (±SD) serum creatinine levels (1.1 ± 0.5 vs. 1.0 ± 0.4; [Formula: see text]). Diabetic patients had similar World Health Organization functional class at presentation but were more likely to have pulmonary venous etiology of PH (24% vs. 10%; [Formula: see text]). Echo findings, including biventricular function, tricuspid regurgitation, and pressure estimates were similar. Invasive pulmonary pressures and cardiac output were similar, but right atrial pressure was appreciably higher (14 ± 8 mmHg vs. 10 ± 5 mmHg; [Formula: see text]). Despite similar management, survival was markedly worse and remained so after statistical adjustment. In summary, diabetic patients referred for assessment of PH were more likely to have pulmonary venous disease than nondiabetic patients with PH, with hemodynamics suggesting greater right-sided diastolic dysfunction. The markedly worse survival in these patients merits further study.
糖尿病在多种疾病状态下使管理复杂化，并对生存率产生不利影响；糖尿病对肺动脉高压（PH）患者的影响尚未得到很好的描述。最近已经证明 PH 存在胰岛素抵抗，因此我们试图研究糖尿病对这些患者的影响。为了对 261 例因初始血流动力学评估而转诊的 PH 患者进行前瞻性研究，收集了人口统计学特征、超声心动图数据和有创血流动力学数据。糖尿病的定义为有记录的胰岛素抵抗或使用抗糖尿病药物治疗。55 例（21%）患者患有糖尿病，与非糖尿病患者相比，他们年龄更大（平均年龄 ± 标准差，61 ± 13 岁比 56 ± 16 岁；[公式：见文本]）、更有可能是黑人（29%比 14%；[公式：见文本]）和高血压（71%比 30%；[公式：见文本]），且血清肌酐水平更高（1.1 ± 0.5 比 1.0 ± 0.4；[公式：见文本]）。糖尿病患者在就诊时的世界卫生组织功能分级相似，但更有可能患有 PH 的肺静脉病因（24%比 10%；[公式：见文本]）。超声心动图结果，包括双心室功能、三尖瓣反流和压力估计，相似。有创性肺压和心输出量相似，但右心房压明显较高（14 ± 8mmHg 比 10 ± 5mmHg；[公式：见文本]）。尽管进行了相似的治疗，但糖尿病患者的生存率明显较差，且在进行统计学调整后仍然如此。总之，与非糖尿病 PH 患者相比，因 PH 评估而转诊的糖尿病患者更有可能患有肺静脉疾病，且血流动力学提示右心舒张功能障碍更严重。这些患者的生存率明显较差，值得进一步研究。
