Ruddy T D, Shumak S L, Liu P P, Barnie A, Seawright S J, McLaughlin P R, Zinman B
Department of Medicine, Toronto General Hospital, Ontario, Canada.
J Clin Endocrinol Metab. 1988 Jan;66(1):113-8. doi: 10.1210/jcem-66-1-113.
The presence of diabetic cardiomyopathy and its relationship to concurrent hormonal and metabolic status have not been defined in patients with uncomplicated type I diabetes mellitus. Accordingly, radionuclide left ventricular angiograms and simultaneous metabolic profiles were obtained in 8 type I diabetic patients who had no major diabetic complications and in 11 normal subjects. Occult coronary artery disease was excluded by electrocardiogram exercise testing. Hemodynamics and systolic function did not differ between the groups. However, the peak filling rate (PFR; end-diastolic volumes per s) was less in the diabetic patients at rest [mean, 4.1 +/- 0.2 (+/- SE) vs. 4.8 +/- 0.2; P less than 0.05] and during aerobic (6.8 +/- 0.2 vs. 8.30 +/- 0.3; P less than 0.01) and anaerobic exercise (8.8 +/- 0.3 vs. 9.8 +/- 0.4; P less than 0.05). The time to PFR was prolonged in the diabetic patients at rest (174 +/- 10 vs. 133 +/- 7 ms; P less than 0.01) and during anaerobic exercise (126 +/- 5 vs. 103 +/- 6 ms; P less than 0.01). Plasma glucose and insulin levels were elevated in the diabetic patients at rest and during exercise. Otherwise, the metabolic and hormonal levels did not differ between the groups. In the diabetic patients, no single metabolic or hormonal parameter correlated with PFR or time to PFR. Impairment of diastolic filling also did not correlate with level of glycosylated hemoglobin or duration of diabetes. The alteration in diastolic filling present in type I diabetic patients who have no other diabetic complications may represent the earliest functional effect of diabetic cardiomyopathy.
在无并发症的I型糖尿病患者中，糖尿病性心肌病的存在及其与同时存在的激素和代谢状态的关系尚未明确。因此，对8例无严重糖尿病并发症的I型糖尿病患者和11名正常受试者进行了放射性核素左心室血管造影及同步代谢指标检测。通过心电图运动试验排除隐匿性冠状动脉疾病。两组间血流动力学和收缩功能无差异。然而，糖尿病患者静息时的峰值充盈率（PFR；每秒舒张末期容积）较低[平均值，4.1±0.2（±标准误）对4.8±0.2；P<0.05]，有氧运动时（6.8±0.2对8.30±0.3；P<0.01）和无氧运动时（8.8±0.3对9.8±0.4；P<0.05）也是如此。糖尿病患者静息时（174±10对133±7毫秒；P<0.01）和无氧运动时（126±5对103±6毫秒；P<0.01）达到PFR的时间延长。糖尿病患者静息和运动时血浆葡萄糖和胰岛素水平升高。除此之外，两组间代谢和激素水平无差异。在糖尿病患者中，没有单一的代谢或激素参数与PFR或达到PFR的时间相关。舒张期充盈受损也与糖化血红蛋白水平或糖尿病病程无关。无其他糖尿病并发症的I型糖尿病患者存在的舒张期充盈改变可能代表糖尿病性心肌病的最早功能效应。
