天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 187-191.doi: 10.11958/20161034

• 临床研究 • 上一篇    下一篇

2 型糖尿病合并非酒精性脂肪肝患者微量白蛋白尿和心脏舒张功能的关系

王德满 1， 邸阜生 2△   

  1. 1 天津医科大学三中心临床学院（邮编 300170）， 工作单位： 天津医科大学总医院滨海医院内分泌科； 2 天津市第三中心医院、天津市人工细胞重点实验室
  • 收稿日期:2016-09-23 修回日期:2016-12-12 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail：difusheng@vip.163.com E-mail:tj-hg-wangdeman@163.com
  • 作者简介:王德满 （1977）， 男， 主治医师， 主要从事糖尿病及其并发症， 甲状腺疾病等方面的研究

The relationship between microalbuminuria and cardiac diastolic function in patients with type II diabetes mellitus and nonalcoholic fatty liver disease

WANG De-man1, DI Fu-sheng2△   

  1. 1 The Third Central Clinical Medical College of Tianjin Medical University, Tianjin 300170，China; Binhai Hospital of Tianjin Medical University General Hospital; 2 Tianjin Third Central Hospital， Key Laboratory of Regenerative Medicine
  • Received:2016-09-23 Revised:2016-12-12 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail： difusheng@vip.163.com E-mail:tj-hg-wangdeman@163.com

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摘要： 目的 探讨 2 型糖尿病 （T2DM） 合并非酒精性脂肪肝 （NAFLD） 患者微量白蛋白尿与心脏舒张功能之间的关系。方法 选择 T2DM 合并 NAFLD 患者 262 例， 按照心脏舒张功能是否正常分为正常组 106 例和异常组 156 例， 比较 2 组腰围（WC）、 低密度脂蛋白胆固醇（LDL-C）、 三酰甘油（TG）、 收缩压（SBP）、 舒张压（DBP）、 空腹血糖（FBG）、 空腹胰岛素 （FINS）、 胰岛素抵抗指数 （HOMA-IR）、 糖化血红蛋白 （HbA1c）、 肾小球滤过率 （GFR）、 C 反应蛋白（CRP）、 微量白蛋白尿排泄率（UAER）、 心肌质量指数（LVWI）、 肝脏脂肪含量（LFC）的差异。全部患者按 UAER<20 μg/min 及 GFR≥90 mL/（min·1.73 m2）为 A 组， UAER<20 μg/min 及 GFR<90 mL/（min·1.73 m2）为 B 组； UAER≥20 μg/min 及 GFR≥90 mL/ （min·1.73 m2）为 C 组， UAER≥20 μg/min 及 GFR<90 mL/ （min·1.73 m2）为 D 组。分析各组相关指标的差异。对 UAER 正常组 （<20 μg/min） 和异常组 （≥20 μg/min） 分别进行 Logistic 回归分析相关因素与舒张功能降低的关系。结果 异常组 TG、 SBP、 HOMA-IR、 CRP、 UAER、 LVWI 和 LFC 均高于正常组 （P＜0.05）， GFR 低于正常组（P＜0.05）。2 组其他指标差异无统计学意义。A、 B、 C 及 D 组舒张早期血流峰值速度/舒张晚期血流峰值速度（E/A）呈依次降低趋势（P＜0.05）， 而 LVWI 呈依次升高趋势（P＜0.05）， C、 D 组 LFC 明显高于其他 2 组（P＜0.05）， A、 B 组间 LFC 比较差异无统计学意义。UAER 正常组 GFR＜90 mL/ （min·1.73 m2） 为心脏舒张功能降低的独立危险因素； UAER 异常组较高 UAER 是心脏舒张功能降低的独立危险因素。结论 T2DM 伴 NAFLD 同时并发微量白蛋白尿的患者心脏舒张功能明显减低， UAER≥20 μg/min 时， 较高 UAER 是心脏舒张功能降低的独立危险因素。

关键词: 糖尿病, 2 型, 脂肪肝, 非酒精性, 微量白蛋白尿, 心脏舒张功能

Abstract: Objective To study the relationship between microalbuminuria and cardiac diastolic function in patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). Methods A total of 262 patients with T2DM and NAFLD were included in this study. Patients were divided into normal group (n=106) and abnormal group (n= 156) according to their cardiac diastolic function. Data of waist circumference (WC), low density lipoprotein cholesterol (LDL-C), triglyceride(TG), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), fasting insulin level (FINS), insulin resistance index (HOMA- IR), glycosylated hemoglobin (HbA1c), glomerular filtration rate (GFR), C reactive protein (CRP), urinary microalbuminuria excretion rate (UAER), left ventricular myocardial quality index (LVWI) and liver fat content (LFC) were compared between two groups. All patients were divided into four groups according to data of UAER and GFR: group A[UAER<20 μg/min and GFR≥90 mL/(min·1.73 m2)], group B [UAER<20 μg/min and GFR<90 mL/(min·1.73 m2)], group C [UAER≥20 μg/min and GFR≥90 mL/(min·1.73 m2)], and group D [UAER≥20 μg/min and GFR<90 mL/(min·1.73 m2)]. The differences between the relevant indicators were analyzed between groups. Logistic regression analysis was used to compare UAER between normal group and abnormal group. Also the relationship between the related factors and cardiac diastolic function was compared between these two groups. Results For abnormal group, TG, SBP, HOMA- IR, CRP, UAER, LVWI and LFC were significantly higher, and GFR was significantly lower, than those of normal group (P＜0.05). There were no significant differences in other indicators between two groups. Values of peak early/ late diastolic filling velocity (E/A) showed a reduction trend in order in A, B， C and D groups (P＜0.05). Values of LVWI showed a increasing trend in order in four groups (P＜0.05). Values of LFC were significantly higher in C and D groups compared with those of A and B groups (P＜0.05). There was no significant difference in LFC between A group and B group. The GFR <90 mL/ （min·1.73 m2） was an independent risk factor for cardiac diastolic function in normal group of UAER, and higher UAER was an independent risk factor for cardiac diastolic function in the abnormal group of UAER. Conclusion There is obviously reduced cardiac diastolic function in patients with T2DM and NAFLD and microalbuminuria. When UAER≥20 µg/min, the higher UAER is an independent risk factor for reducing diastolic cardiac dysfunction.

Key words: diabetes mellitus, type 2, fatty liver, non-alcoholic, microalbuminuria, cardiac diastolic function