胰岛素依赖型糖尿病年轻患者的左心室充盈：一项负荷多普勒超声心动图研究

Left ventricular filling in young patients affected by insulin-dependent diabetes mellitus: a stress Doppler echocardiographic study.

作者信息

Borgia M C, Pellicelli A M, Medici F, Barba Cosial J, Cabañero J, Huelmos A, De Paola G, Lionetti M

机构信息

Institute of Medicine, University of Rome La Sapienza, Italy.

出版信息

Panminerva Med. 1998 Sep;40(3):204-9.

PMID:9785918

Abstract

BACKGROUND

The purpose of this study was to analyze diastolic function in two different populations of young patients affected by insulin dependent diabetes mellitus (IDDM), with and without systemic diabetic complications, and to compare the results obtained at rest with those obtained during isometric exercise.

METHODS

Forty-five IDDM diabetic patients were studied. On the basis of presence or absence of systemic diabetic complications (nephropathy and retinopathy) patients were divided into two groups. Group I (20 patients) without and Group II (25 patients) with diabetic complications. Diastolic function parameters were measured by Doppler echocardiography at rest and during isometric exercise. The two groups were similar regarding age, metabolic control and insulin dosage but there were significant differences in diastolic and systolic blood pressure and heart rate between the two groups, the patients with complications showing higher values (p < 0.001, p < 0.005, p < 0.01 respectively).

RESULTS

Group II already presented at rest alterations of diastolic function parameters respect to Group I with a marked increase of: peak velocity of late left ventricular filling (peakA cm/sec), (60.1 +/- 13.4 versus 48.4 +/- 8.9, p < 0.01); late left ventricular filling integral (A area), (6.5 +/- 1.4 versus 5.0 +/- 0.8, p < 0.05); late left ventricular filling integral over total filling (A area/total area), (0.31 +/- 0.06 versus 0.26 +/- 0.06, p < 0.01). There was a decrease of E/A ratio in Group II versus Group I (1.5 +/- 0.32 versus 1.9 +/- 0.5, p < 0.05). During isometric exercise these changes became even more pronounced in patients with complications and in this group there was a marked decrease of flow integral of early left ventricular filling over total filling (E area/total area), (0.57 +/- 0.09 versus 0.68 +/- 0.07, p < 0.01).

CONCLUSIONS

In conclusion, young IDDM patients with complications show an impairment of diastolic function more pronounced than those without. These changes are more evident during isometric exercise. Stress Doppler echocardiography is a reliable tool to detect early diastolic dysfunction in diabetic patients.

摘要

背景

本研究的目的是分析两组不同的胰岛素依赖型糖尿病（IDDM）年轻患者的舒张功能，一组有全身性糖尿病并发症，另一组没有，并将静息状态下获得的结果与等长运动期间获得的结果进行比较。

方法

对45例IDDM糖尿病患者进行了研究。根据是否存在全身性糖尿病并发症（肾病和视网膜病变），将患者分为两组。第一组（20例患者）无并发症，第二组（25例患者）有糖尿病并发症。通过多普勒超声心动图在静息状态和等长运动期间测量舒张功能参数。两组在年龄、代谢控制和胰岛素剂量方面相似，但两组之间的舒张压、收缩压和心率存在显著差异，有并发症的患者这些值更高（分别为p < 0.001、p < 0.005、p < 0.01）。

结果

与第一组相比，第二组在静息状态下舒张功能参数就已出现改变，表现为以下指标显著增加：左心室晚期充盈峰值速度（peakA cm/秒），（60.1±13.4对48.4±8.9，p < 0.01）；左心室晚期充盈积分（A面积），（6.5±1.4对5.0±0.8，p < 0.05）；左心室晚期充盈积分占总充盈积分的比例（A面积/总面积），（0.31±0.06对0.26±0.06，p < 0.01）。与第一组相比，第二组的E/A比值降低（1.5±0.32对1.9±0.5，p < 0.05）。在等长运动期间，这些变化在有并发症的患者中变得更加明显，并且在该组中，左心室早期充盈血流积分占总充盈积分的比例（E面积/总面积）显著降低，（0.57±0.09对0.68±0.07，p < 0.01）。