肥胖对2型糖尿病患者左室结构和功能的影响

梁丽媚; 刘红利; 张会欣; 何鑫; 赵世光

doi:10.12125/j.chj.202106100

肥胖对2型糖尿病患者左室结构和功能的影响

Impact of obesity on left ventricular geometry and function in type 2 diabetes mellitus patients

摘要

摘要:
目的联合应用常规超声心动图和三维斑点追踪成像分析2型糖尿病（T2DM）无肥胖或合并肥胖患者的左室结构和功能，探讨可能影响这些患者左室整体应变的危险因素。
方法 95例T2DM患者，根据是否合并肥胖分为T2DM无肥胖组（n=45，BMI<25 kg/m²）；T2DM合并肥胖组（n=50，BMI≥25 kg/m²）。选取30例年龄与性别相匹配的健康志愿者作为对照组。所有入组者进行常规超声心动图和三维斑点追踪成像检查。
结果在左室二维几何构型方面，与对照组比较，T2DM组的左室重构更为普遍（P<0.05），T2DM合并肥胖组的左室肥厚最多见（P<0.05）。在左室舒张功能方面，T2DM无肥胖组e’明显减低（P<0.05），E/e’明显增大（P<0.05）；T2DM合并肥胖组的e’明显减低（P<0.05），左房容积指数与E/e’明显增大（P<0.05）。在左室收缩功能方面，与对照组比较，T2DM无肥胖组整体纵向应变（GLS）明显减低（P<0.05）；T2DM合并肥胖组的GLS、整体圆周应变（GCS）、整体面积应变（GAS）、整体径向应变（GRS）均低于其他两组（均P<0.05）。多元回归分析显示，糖化血红蛋白（HbA1c）与体质量指数（BMI）是左室各个方向整体应变的影响因素；相对室壁厚度（RWT）与左室质量指数（LVMI）对部分方向的整体应变有负向影响。
结论肥胖可能会加重T2DM患者的左室重构和功能障碍，联合应用常规超声心动图和三维斑点追踪成像可以检测出亚临床左室异常。

Abstract:
AIM To evaluate the impact of obesity on left ventricular geometry and functions in type 2 diabetes mellitus (T2DM) patients using conventional echocardiography and three-dimensional speckle tracking imaging and to explore the risk factors that could affect left ventricular strain values in these patients.
METHODS Ninety-five T2DM patients were divided into T2DM without obesity group (n=45, BMI<25 kg/m²) and T2DM with obesity group (n=50, BMI≥25 kg/m²). Thirty age-and-gender matched healthy volunteers were selected as the controls. Conventional echocardiography and three-dimensional speckle tracking imaging were performed for all participants.
RESULTS Significant differences in left ventricular geometry were found between the three groups (P<0.05). Compared with those in the controls, left ventricular remodeling was more prevalent in the T2DM patients and left ventricular hypertrophy was most prevalent in the T2DM with obesity group. Compared with those in the controls, e' in T2DM without obesity group was significantly lower (P<0.05) and E/e' was significantly increased (P<0.05). Both the left atrial volume index and E/e' in T2DM with obesity group were significantly increased (P<0.05), while e' was significantly decreased (P<0.05). Global longitudinal strain in T2DM without obesity group was significantly lower than that in the controls (P<0.05). The global longitudinal strain, global circumferential strain, global area strain, and global radial strain values in T2DM with obesity group were all significantly lower than those in the controls (all P<0.05) and were also significantly lower than those in T2DM without obesity group. Both HbA1c and BMI were independently associated with all strain values in patients with T2DM. RWT and LVMI had negative effects on some directions strain.
CONCLUSION Obesity may exacerbate left ventricular remodeling and left ventricular dysfunction in T2DM patients, and these subclinical left ventricular abnormalities with retained ejection fraction can be detected using conventional echocardiography and three-dimensional speckle-tracking imaging.

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