【摘要】 目的探讨老年2型糖尿病患者病程及血脂指标与心脏结构及功能改变的相关性。方法前瞻性选择2019年4月至2020年4月保定市第三中心医院内分泌科确诊并收治的老年2型糖尿病患者85例作为糖尿病组,按照病程不同分为<5年24例,5～10年22例,11～15年20例,> 15年19例;选择同时期内健康体检者60名作为对照组。比较不同病程组和对照组血脂指标[低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)]及心脏结构、功能指标[左心房内径(LAD)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、室间隔厚度(LVSd)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、二尖瓣口舒张早期血流充盈速度(E)、二尖瓣口舒张晚期血流充盈速度(A)、二尖瓣口舒张早期/晚期血流充盈速度(E/A)],分析病程、血脂指标与心脏结构、功能指标的相关性。结果糖尿病组E、E/A、HDL-C值低于对照组,而A、LDL-C、TG值高于对照组,差异均有统计学意义(P <0.05); LAD、LVEDd、LVESd、LVSd、LVEF、LVFS、TC值比较,差异均无统计学意义(P> 0.05)。不同病程组LAD、LVEDd、LVESd、LVSd、LVEF、LVFS、E、TG、TC值比较,差异均无统计学意义(P> 0.05);病程<5年组、5～10年组、11～15年组、> 15年组,E/A、HDL-C值依次减低,A、LDL-C值依次增加,组内两两比较差异均有统计学意义(P <0.05)。LVSd改变、E/A <1与病程、HDL-C呈负相关,与LDL-C呈正相关(P <0.05)。病程增加、LDL-C≥2.30 mmol/L、HDL-C <2.30 mmol/L是心脏结构、舒张功能异常高危因素(P <0.05)。结论老年2型糖尿病患者病程增加及血脂指标LDL-C、HDL-C的变化与心脏结构及功能异常密切相关。更多还原

【Abstract】 Objective To investigate the correlation between the course of disease and serum lipids in elderly patients with type 2 diabetes mellitus and the changes in cardiac structure and function. Methods From April 2019 to April 2020,85 elderly patients with type 2 diabetes who were diagnosed and admitted to the Department of Endocrinology,Baoding Third Central Hospital were prospectively selected as the diabetes group,including 24 patients with disease course < 5 years,22 patients with disease course ranging from 5 to 10 years,20 patients with disease duration ranging from 11 to 15 years,and 19 patients with disease course > 15 years. Another 60 healthy individuals were also enrolled as the control group. Then comparison was performed among various indexes,including blood lipid indicators [low-density lipoprotein cholesterol (LDL-C),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C),total cholesterol (TC) ] and cardiac structure and function indicators [left atrial diameter (LAD),left ventricular end-diastolic diameter (LVEDd),left ventricular end-systolic diameter (LVESd),ventricular septal thickness (LVSd),left ventricular ejection fraction (LVEF),left ventricular fraction shortening (LVFS),peak flow velocity of early diastole during atrial contraction (E),peak flow velocity of late diastole during atrial contraction (A),E/A]. the course of disease,blood lipid indicators and cardiac structure,functional indicators were aralyzed. Results The values of E,E/A and HDL-C in the diabetic group were lower than those in the control group,while the values of A,LDL-C and TG in the diabetic group were higher than those in the control group,the differences were statistically significant (P < 0. 05); there were no significant differences in LAD,LVEDd,LVESD,LVSD,LVEF,LVFS and TC (P > 0. 05). There were no significant differences in LAD,LVEDd,LVESD,LVSD,LVEF,LVFS,E,TG and TC among different course groups (P > 0. 05); the E/A and HDL-C values decreased in the < 5 years group,5-10 years group,11-15 years group and > 15 years group,while the A and LDL-C values increased in turn,and the differences were statistically significant (P < 0. 05). LVSd changes,E/A <1 were negatively correlated with the course of disease and HDL-C,and positively correlated with LDL-C (P < 0. 05). Increased course of disease,LDL-C≥2. 30 mmol/L and HDL-C < 2. 30 mmol/L were risk factors for abnormal cardiac structure and diastolic function (P < 0. 05).Conclusion The increase of the course of elderly patients with type 2 diabetes mellitus and the changes of LDL-C and HDL-C are closely related to the abnormality of heart structure and function.更多还原