采用组织多普勒超声心动图评估无已知心脏病的1型糖尿病患者的早期心肌损伤：千一研究。
Early myocardial impairment in type 1 diabetes patients without known heart disease assessed with tissue Doppler echocardiography: The Thousand & 1 study.
作者信息
Jensen Magnus Thorsten, Sogaard Peter, Andersen Henrik Ullits, Gustafsson Ida, Bech Jan, Hansen Thomas Fritz, Theilade Simone, Almdal Thomas, Rossing Peter, Jensen Jan Skov
机构信息
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Steno Diabetes Center, Gentofte, Denmark Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Faculty of Medicine, Aalborg University, Aalborg, Denmark.
出版信息
Diab Vasc Dis Res. 2016 Jul;13(4):260-7. doi: 10.1177/1479164116637310. Epub 2016 Apr 21.
PURPOSE
Cardiovascular disease is the most common cause of mortality in type 1 diabetes; patients with albuminuria are at greatest risk. We investigated myocardial function and premature myocardial impairment in type 1 diabetes patients with and without albuminuria compared to controls.
METHODS
This study included a cross-sectional survey of 1093 type 1 diabetes patients from Steno Diabetes Center and 200 healthy controls. Conventional and tissue Doppler echocardiographic measurements were analysed in multivariable models in normoalbuminuria (n = 760), microalbuminuria (n = 227) and macroalbuminuria (n = 106). Investigators were blinded to degree of albuminuria.
RESULTS
For the type 1 diabetes patients, mean age was 49.6 years, 53% were men and mean diabetes duration was 25.5 years. In multivariable models systolic velocity s' did not differ between type 1 diabetes patients with normoalbuminuria and controls (β-coefficient [95% confidence interval]: -0.17 [-0.41; 0.08], p = 0.19), but was impaired between controls and microalbuminuria (-0.53 [-0.84; -0.23], p = 0.001) and macroalbuminuria (-0.59 [-0.96; -0.22], p = 0.002). Diastolic measurements (e', a', e'/a', and E/e') were all significantly impaired in type 1 diabetes, for example, e'/a': normoalbuminuria, microalbuminuria and macroalbuminuria versus controls: -0.38 [-0.52; -0.23], p < 0.001; -0.49 [-0.67; -0.32], p < 0.001; and -0.81 [-1.03; -0.59], p < 0.001. In age-related analyses, myocardial impairment occurred prematurely in type 1 diabetes compared to controls (e.g. E/e' = 8; 9.2 years [normoalbuminuria], 17.3 years [microalbuminuria] and 41.4 years [macroalbuminuria] prematurely, respectively).
CONCLUSION
In type 1 diabetes patients with albuminuria, both systolic and diastolic functions are impaired, whereas in patients without albuminuria only diastolic function is affected. Myocardial impairment is detectable many years prematurely in type 1 diabetes, especially in patients with albuminuria.
目的
心血管疾病是1型糖尿病患者最常见的死亡原因；蛋白尿患者风险最高。我们比较了有和没有蛋白尿的1型糖尿病患者与对照组的心肌功能和心肌过早损伤情况。
方法
本研究包括对来自斯滕诺糖尿病中心的1093例1型糖尿病患者和200例健康对照进行横断面调查。在正常白蛋白尿组（n = 760）、微量白蛋白尿组（n = 227）和大量白蛋白尿组（n = 106）的多变量模型中分析了常规和组织多普勒超声心动图测量结果。研究人员对白蛋白尿程度不知情。
结果
1型糖尿病患者的平均年龄为49.6岁，53%为男性，平均糖尿病病程为25.5年。在多变量模型中，正常白蛋白尿的1型糖尿病患者与对照组之间的收缩期速度s'无差异（β系数[95%置信区间]：-0.17[-0.41；0.08]，p = 0.19），但对照组与微量白蛋白尿组（-0.53[-0.84；-0.23]，p = 0.001）和大量白蛋白尿组（-0.59[-0.96；-0.22]，p = 0.002）之间的s'受损。1型糖尿病患者的舒张期测量值（e'、a'、e'/a'和E/e'）均显著受损，例如，e'/a'：正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组与对照组相比：-0.38[-0.52；-0.23]，p < 0.001；-0.49[-0.67；-0.32]，p < 0.001；-0.81[-1.03；-0.59]，p < 0.001。在年龄相关分析中，与对照组相比，1型糖尿病患者的心肌损伤出现过早（例如，E/e' = 8时，分别提前9.2年[正常白蛋白尿]、17.3年[微量白蛋白尿]和41.4年[大量白蛋白尿]）。
结论
有蛋白尿的1型糖尿病患者的收缩和舒张功能均受损，而无蛋白尿的患者仅舒张功能受影响。1型糖尿病患者的心肌损伤可提前多年检测到，尤其是有蛋白尿的患者。
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