Zhang Xiunan, Jiang Cuiping, Ye Zhibin, Zhang Yinjia, Zhang Xiaoli
Department of Nephrology, Huadong Hospital, Fudan University, Shanghai, China.
Department of Endocrinology, Huadong Hospital, Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2025 Jun 16;16:1547078. doi: 10.3389/fendo.2025.1547078. eCollection 2025.
To assess cardiac function using two-dimensional speckle-tracking echocardiography (2D-STI) in diabetic nephropathy (DN) patients and investigate the relationship between albuminuria and early cardiac systolic and diastolic dysfunction, along with associated risk factors based on clinical indicators.
A total of 75 patients with DN, 100 patients with diabetes mellitus (DM), and 37 healthy controls were recruited. Clinical data were collected, and conventional echocardiography as well as 2D-STI were performed on all participants.
2D-STI findings revealed a significant increased occurrence rate of subclinical left ventricular systolic dysfunction [global longitudinal strain values (GLS) <18%], among diabetic patients compared to healthy controls. Furthermore, the proportion of GLS<18% occurrence was higher in the DN group compared to the DM group (p<0.001) and especially higher in the massive albuminuria group than that in the microalbuminuria group (<0.001). The results demonstrated that albuminuria, eGFR<60 ml/min/1.73 m, and total cholesterol were identified as significant risk factors for the development of subclinical left ventricular systolic insufficiency in diabetic patients. However, when considering only patients with DN and adjusting for covariates, it was found that only total cholesterol remained statistically significant (< 0.05).
The higher cholesterol levels in patients with DN are associated with a greater risk of subclinical left ventricular systolic dysfunction reflected by a decrease in GLS assayed with 2D-STI.
GLS measured by 2D-STI combined with clinical indexes to evaluate and predict subclinical left ventricular systolic function in patients with DM, providing reference for early prevention and treatment of cardiac dysfunction in patients with DN.
运用二维斑点追踪超声心动图（2D-STI）评估糖尿病肾病（DN）患者的心脏功能，探讨蛋白尿与早期心脏收缩和舒张功能障碍之间的关系，以及基于临床指标的相关危险因素。
共招募了75例DN患者、100例糖尿病（DM）患者和37例健康对照者。收集临床资料，并对所有参与者进行常规超声心动图检查以及2D-STI检查。
2D-STI检查结果显示，与健康对照者相比，糖尿病患者中亚临床左心室收缩功能障碍[整体纵向应变值（GLS）<18%]的发生率显著增加。此外，DN组中GLS<18%的发生率高于DM组（p<0.001），尤其是大量蛋白尿组高于微量蛋白尿组（<0.001）。结果表明，蛋白尿、估算肾小球滤过率（eGFR）<60 ml/min/1.73 m²以及总胆固醇被确定为糖尿病患者发生亚临床左心室收缩功能不全的重要危险因素。然而，仅考虑DN患者并对协变量进行校正后，发现只有总胆固醇仍具有统计学意义（<0.05）。
DN患者较高的胆固醇水平与2D-STI检测的GLS降低所反映的亚临床左心室收缩功能障碍风险增加相关。
通过2D-STI测量的GLS结合临床指标来评估和预测DM患者的亚临床左心室收缩功能，为DN患者心脏功能障碍的早期防治提供参考。
