Kimball T R, Daniels S R, Khoury P R, Magnotti R A, Turner A M, Dolan L M
Division of Cardiology, University of Cincinnati, College of Medicine, Ohio.
Circulation. 1994 Jul;90(1):357-61. doi: 10.1161/01.cir.90.1.357.
Although the existence of diabetic cardiomyopathy in adults is firmly established, the presence of cardiac abnormalities in young diabetic patients is not universally accepted. We sought to determine the early stages of cardiac derangement and whether they are associated with renal dysfunction.
Thirty-nine patients (29 boys; mean age, 17.6 +/- 3.4 years) with insulin-dependent diabetes mellitus underwent echocardiography and timed overnight urine collection. Echocardiographic evaluation consisted of left ventricular mass, performance (shortening fraction, velocity of circumferential fiber shortening, stroke volume, and cardiac index), preload (end-diastolic dimension and volume), after-load (end-systolic wall stress and systemic vascular resistance), and contractility (velocity of fiber shortening relative to wall stress). Creatinine clearance and albumin excretion were measured from the urine sample. Glycosylated hemoglobin levels were measured; height and weight were measured; and Quetelet index (weight/height2) was calculated. These data were compared with control data. Left ventricular mass (26 +/- 6 versus 22 +/- 6 g/ht2.7, P < .01), the indexes of performance, blood pressure, and contractility (0.14 +/- 0.14 versus 0.003 +/- 0.03 circumference/s, P < .0003) were significantly higher in the diabetic patients than in control subjects. To evaluate the correlates of left ventricular mass and contractility in the diabetic patients, univariate and multiple regression analyses were performed. Significant univariate correlations of mass included albumin excretion (r = .36, P < .02), glycosylated hemoglobin (r = .35, P < .04), and stroke volume (r = .34, P < .03). A multivariate model included Quetelet index, albumin excretion, and duration of diabetes. Significant univariate correlations of contractility included insulin dosage (r = -.36, P < .02), creatinine clearance (r = .40, P < .02), and Quetelet index (r = .34, P < .03). A multivariate model included insulin dosage and creatinine clearance.
Early onset of diabetes mellitus is associated with increased left ventricular mass, performance, contractility, and blood pressure. These cardiovascular findings are correlated with increased creatinine clearance and microalbuminuria. These relations suggest that alterations in cardiovascular and renal function may occur in parallel in adolescents with insulin-dependent diabetes mellitus.
尽管成人糖尿病性心肌病的存在已被明确证实，但年轻糖尿病患者存在心脏异常这一观点并未得到普遍认可。我们试图确定心脏功能紊乱的早期阶段以及它们是否与肾功能障碍有关。
39例胰岛素依赖型糖尿病患者（29名男性；平均年龄17.6±3.4岁）接受了超声心动图检查和定时过夜尿液收集。超声心动图评估包括左心室质量、功能（缩短分数、圆周纤维缩短速度、每搏输出量和心脏指数）、前负荷（舒张末期内径和容积）、后负荷（收缩末期壁应力和体循环血管阻力）以及收缩性（纤维缩短速度相对于壁应力）。从尿液样本中测量肌酐清除率和白蛋白排泄量。测量糖化血红蛋白水平；测量身高和体重；计算体重指数（体重/身高²）。将这些数据与对照数据进行比较。糖尿病患者的左心室质量（26±6对22±6 g/ht².7，P<.01）、功能指标、血压和收缩性（0.14±0.14对0.003±0.03周径/秒，P<.0003）显著高于对照组。为了评估糖尿病患者左心室质量和收缩性的相关因素，进行了单因素和多因素回归分析。质量的显著单因素相关性包括白蛋白排泄量（r=.36，P<.02）、糖化血红蛋白（r=.35，P<.04）和每搏输出量（r=.34，P<.03）。多因素模型包括体重指数、白蛋白排泄量和糖尿病病程。收缩性的显著单因素相关性包括胰岛素剂量（r=-.36，P<.02）、肌酐清除率（r=.40，P<.02）和体重指数（r=.34，P<.03）。多因素模型包括胰岛素剂量和肌酐清除率。
糖尿病的早期发病与左心室质量增加、功能、收缩性和血压升高有关。这些心血管发现与肌酐清除率增加和微量白蛋白尿相关。这些关系表明，胰岛素依赖型糖尿病青少年的心血管和肾功能改变可能同时发生。
