血糖控制不理想对2型糖尿病患者亚临床心肌收缩功能的影响研究

doi:10.3969/j.issn.1674-8115.2023.08.010

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (8): 1024-1031.doi: 10.3969/j.issn.1674-8115.2023.08.010

• 论著 · 临床研究 • 上一篇

血糖控制不理想对2型糖尿病患者亚临床心肌收缩功能的影响研究

吴凌恒¹^,²(), 陈建雄¹, 张梦娇³, 沙蕾⁴, 曹萌萌⁴, 沈崔琴⁴, 杜联芳², 李朝军²^,⁴()

^1.福建医科大学附属闽东医院超声医学科，宁德 355000
^2.上海交通大学附属第一人民医院超声影像科，上海 200080
^3.潍坊医学院医学影像系，潍坊 261053
^4.上海市第一人民医院嘉定分院超声科，上海 201803

收稿日期:2023-04-01 接受日期:2023-07-21 出版日期:2023-08-28 发布日期:2023-08-28
通讯作者: 李朝军 E-mail:wulingheng66@163.com;lzj_1975@sina.com
作者简介:吴凌恒（1995—），女，住院医师，硕士生；电子信箱：wulingheng66@163.com。
基金资助:
上海市自然科学基金(21ZR1451400);上海市卫生健康委员会卫生行业临床研究专项(202240235);上海市嘉定区卫生和计划生育委员会基金(2021-KY-10);福建医科大学启航基金(2022QH1232)

A study of the effect of suboptimal glycemic control on subclinical myocardial systolic function in patients with T2DM

WU Lingheng¹^,²(), CHEN Jianxiong¹, ZHANG Mengjiao³, SHA Lei⁴, CAO Mengmeng⁴, SHEN Cuiqin⁴, DU Lianfang², LI Zhaojun²^,⁴()

^1.Department of Ultrasound, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, China
^2.Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
^3.Department of Medical Imaging, Weifang Medical University, Weifang 261053, China
^4.Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai 201803, China

Received:2023-04-01 Accepted:2023-07-21 Online:2023-08-28 Published:2023-08-28
Contact: LI Zhaojun E-mail:wulingheng66@163.com;lzj_1975@sina.com
Supported by:
Natural Science Foundation of Shanghai(21ZR1451400);Shanghai Health and Family Planning Commission Fund(202240235);Shanghai Jiading District Health and Family Planning Commission Fund(2021-KY-10);Startup Fund for scientific research, Fujian Medical University(2022QH1232)

摘要/Abstract

摘要：

目的·探讨血糖控制不理想对2型糖尿病（type 2 diabetes mellitus，T2DM）患者亚临床心脏收缩功能的影响。方法·选取2021年6月—2022年3月于上海市第一人民医院嘉定分院随诊治疗的T2DM患者83例，以糖化血红蛋白（hemoglobin A_1c，HbA_1c）水平分为血糖控制理想（satisfactory control of glycaemia group，SCG）组和血糖控制不理想（less satisfactory control of glycaemia group，LSCG）组，同时选取对照组受试者54例。标准的超声心动图检查后，分别获取左心室结构和功能参数及左室心内膜下层、心肌中层和心外膜下层整体纵向应变（global longitudinal strain，GLS）指标GLS_endo、GLS_mid和GLS_epi。采用方差分析进行参数比较，相关分析采用Pearson相关分析和多元线性回归分析。应用受试者操作特征（receiver operator characteristic，ROC）曲线分析纵向应变以鉴别T2DM患者亚临床心肌功能损害的诊断效能。结果·室间隔厚度和左室后壁厚度在LSCG组均厚于SCG组和对照组（均P<0.05），而在SCG组和对照组间差异无统计学意义（均P>0.05）。与对照组相比，LSCG组和SCG组的左室舒张功能指标二尖瓣口舒张早期血流速度（early peak flow velocity by Doppler，E）/左心室侧壁二尖瓣环舒张早期运动速度（early diastolic velocity of the mitral annulus by tissue Doppler imaging，e）均较大且差异具有统计学意义（均P<0.05），而LSCG和SCG组间的差异无统计学意义（P>0.05）。左心室射血分数在3组间差异无统计学意义（P>0.05）。与LSCG组比较，GLS_endo、GLS_mid、GLS_epi的收缩形变数值在SCG组和对照组均较大（均P<0.05），而在SCG和对照组间差异无统计学意义（P>0.05）。HbA_1c是GLS_mid和GLS_epi的独立负相关影响因素（β值分别为-0.198和-0.239，均P<0.05）。GLS_endo、GLS_mid和GLS_epi在LSCG与SCG组间具有中等诊断效能，曲线下面积（area under the curve，AUC）分别为0.754（95%CI 0.624~0.884）、0.755（95%CI 0.624~0.885）和0.751（95%CI 0.619~0.882）。结论·血糖控制不理想的T2DM患者心肌收缩功能减低，这种亚临床心肌损害与HbA_1c水平呈独立负相关。

关键词: 超声心动图, 2型糖尿病, 应变, 糖化血红蛋白, 二维斑点追踪成像

Abstract:

Objective ·To explore the relationship between poor blood glucose control and early impaired cardiac function in patients with type 2 diabetes mellitus (T2DM). Methods ·Eighty-three patients diagnosed with T2DM in Jiading Branch of Shanghai General Hospital from June 2021 to March 2022 were selected and divided into two groups according to the level of hemoglobin A_1c(HbA1c): satisfactory control of glycaemia (SCG) group and less satisfactory control of glycaemia (LSCG) group. Fifty-four subjects were in the control group. Echocardiography was performed to obtain left ventricular structural and functional parameters and left ventricular subendocardial, medial and subepicardial global longitudinal strain (GLS): GLS_endo, GLS_mid, and GLS_epi. The parameters were compared by using analysis of variance. The correlation analysis was performed by Pearson correlation analysis and multiple linear regression analysis. The diagnostic performance of longitudinal strain in differentiating subclinical myocardial dysfunction in patients with T2DM was analyzed by receiver operator characteristic (ROC) curve. Results ·The thickness of the ventricular septum and the posterior wall of the left ventricle were thicker in the LSCG group than in the SCG group and the control group (all P<0.05), but there was no significant difference between the SCG and the control group (all P>0.05). Compared with the control group, the left ventricular diastolic function index E/e (early peak flow velocity by Doppler/early and atrial diastolic velocity of the mitral annulus by tissue Doppler imaging) was higher in both the LSCG group and the SCG group (all P <0.05), but there was no significant difference between the LSCG group and SCG group (P>0.05). There was no significant difference in left ventricular ejection fraction among the three groups (P>0.05). Compared with LSCG group, GLS_endo, GLS_mid and GLS_epi were higher in the SCG group and control group (all P<0.05), but there was no significant difference between the SCG group and control group (P>0.05). HbA_1c was an independently negative factor of GLS_mid and GLS_epi (β= -0.198 and -0.239, all P<0.05). GLS_endo, GLS_mid and GLS_epi had moderate diagnostic performance between the LSCG group and SCG group, with areas under the curve (AUC) of 0.754 (95%CI 0.624?0.884), 0.755 (95%CI 0.624?0.885), and 0.751 (95%CI 0.619?0.882), respectively. Conclusions ·T2DM patients with unsatisfactory glycemic control have reduced myocardial contractility, and this subclinical myocardial damage is independently negatively correlated with the level of HbA_1c.

Key words: echocardiography, type 2 diabetes mellitus (T2DM), strain, hemoglobin A_1c (HbA_1c), two-dimensional speckle tracking imaging

中图分类号:

R540.45

吴凌恒, 陈建雄, 张梦娇, 沙蕾, 曹萌萌, 沈崔琴, 杜联芳, 李朝军. 血糖控制不理想对2型糖尿病患者亚临床心肌收缩功能的影响研究[J]. 上海交通大学学报（医学版）, 2023, 43(8): 1024-1031.

WU Lingheng, CHEN Jianxiong, ZHANG Mengjiao, SHA Lei, CAO Mengmeng, SHEN Cuiqin, DU Lianfang, LI Zhaojun. A study of the effect of suboptimal glycemic control on subclinical myocardial systolic function in patients with T2DM[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(8): 1024-1031.

图/表 6

参考文献 23

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Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F/χ² value	P value
Male/n(%)	32 (59.2)	10 (58.8)	40 (60.6)	0.031	0.985
Age/year	54.85±10.62	65.71±7.04^①	60.65±11.93^②	7.839	0.001
Height/cm	164.83±8.12	164.24±7.86	165.74±7.94	0.332	0.718
Weight/kg	63.28±11.15	63.71±13.55	68.32±13.48	2.626	0.076
BMI/(kg·m^-2)	23.23±3.32	23.53±4.24	24.82±4.44	2.499	0.086
SBP/mmHg	127.31±20.80	143.06±24.80^③	143.15±23.84^①	7.868	0.001
DBP/mmHg	78.81±12.11	80.59±15.53	82.76±14.22	1.255	0.288
Pulse/(beats·min^-1)	80.07±12.81	79.47±12.62	79.20±12.89	0.067	0.935
CSBP/mmHg	124.94±17.06	125.71±11.52	129.40±17.24	1.097	0.337
Hypertension/n(%)	0 (0)	3 (17.6)^③	23 (34.8)^①	23.479	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F/χ² value	P value
Male/n(%)	32 (59.2)	10 (58.8)	40 (60.6)	0.031	0.985
Age/year	54.85±10.62	65.71±7.04^①	60.65±11.93^②	7.839	0.001
Height/cm	164.83±8.12	164.24±7.86	165.74±7.94	0.332	0.718
Weight/kg	63.28±11.15	63.71±13.55	68.32±13.48	2.626	0.076
BMI/(kg·m^-2)	23.23±3.32	23.53±4.24	24.82±4.44	2.499	0.086
SBP/mmHg	127.31±20.80	143.06±24.80^③	143.15±23.84^①	7.868	0.001
DBP/mmHg	78.81±12.11	80.59±15.53	82.76±14.22	1.255	0.288
Pulse/(beats·min^-1)	80.07±12.81	79.47±12.62	79.20±12.89	0.067	0.935
CSBP/mmHg	124.94±17.06	125.71±11.52	129.40±17.24	1.097	0.337
Hypertension/n(%)	0 (0)	3 (17.6)^③	23 (34.8)^①	23.479	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F value	P value
TC/(mmol·L^-1)	4.30±1.04	4.44±1.10	4.58±1.26	0.915	0.403
TAG/(mmol·L^-1)	1.41±1.00	1.85±1.04	1.72±1.12	1.745	0.179
HDL-Ch/(mmol·L^-1)	1.10±0.30	1.10±0.37	0.99±0.34	1.785	0.172
LDL-Ch/(mmol·L^-1)	2.85±0.96	2.64±0.93	2.87±1.06	0.348	0.707
FBG/(mmol·L^-1)	5.29±1.28	5.52±1.13	8.30±2.97^①②	29.469	0.000
HbA_1c	5.31±0.82	5.98±0.67	9.19±2.75^①②	60.215	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F value	P value
TC/(mmol·L^-1)	4.30±1.04	4.44±1.10	4.58±1.26	0.915	0.403
TAG/(mmol·L^-1)	1.41±1.00	1.85±1.04	1.72±1.12	1.745	0.179
HDL-Ch/(mmol·L^-1)	1.10±0.30	1.10±0.37	0.99±0.34	1.785	0.172
LDL-Ch/(mmol·L^-1)	2.85±0.96	2.64±0.93	2.87±1.06	0.348	0.707
FBG/(mmol·L^-1)	5.29±1.28	5.52±1.13	8.30±2.97^①②	29.469	0.000
HbA_1c	5.31±0.82	5.98±0.67	9.19±2.75^①②	60.215	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F value	P value
LVEDD/mm	48.09±10.38	46.31±7.41	46.99±7.60	0.366	0.694
LVESD/mm	29.27±3.67	28.64±3.73	33.28±32.92	0.561	0.572
IVSd/mm	8.61±1.02	9.25±1.13	9.48±1.38^①	7.710	0.001
LVPWd/mm	8.52±0.94	8.68±1.16	9.05±1.39^②	2.932	0.057
LVEF/%	0.59±0.09	0.55±0.09	0.56±0.09	1.723	0.183
E/e	6.52±1.64	8.93±3.70^③	8.12±2.93^③	7.991	0.001
e/a	1.16±0.51	0.86±0.42^④	0.82±0.42^⑤	8.467	0.000
GLS_endo/%	-21.35±3.79	-21.88±3.29	-18.46±4.37^⑤⑥	9.532	0.000
GLS_mid/%	-20.27±3.78	-20.75±3.14	-17.47±4.17^⑤⑥	9.489	0.000
GLS_epi/%	-19.22±3.76	-19.56±3.18	-16.23±4.00^⑤⑥	10.966	0.000

血糖控制不理想对2型糖尿病患者亚临床心肌收缩功能的影响研究

A study of the effect of suboptimal glycemic control on subclinical myocardial systolic function in patients with T2DM

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图/表 6

参考文献 23

相关文章 15

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Metrics

Item	Univariate correlation analysis (r value)			Multiple regression analysis (β value)
Item	GLS_endo	GLS_mid	GLS_epi	GLS_endo	GLS_mid	GLS_epi
Age	-0.057	-0.07	-0.103	0.031	0.027	-0.036
BMI	-0.112	-0.103	-0.109	-0.069	-0.069	-0.122
SBP	-0.177^①	-0.186^②	-0.171^③	-0.150	-0.166	-0.188
DBP	-0.071	-0.058	-0.022	0.121	0.146	0.174
CSBP	-0.181^①	-0.194^④	-0.159	-0.115	-0.126	-0.088
LVEDD	-0.035	-0.034	-0.017	-0.022	-0.022	-0.005
LVESD	-0.048	-0.048	-0.028	0.002	0.000	0.019
IVSd	-0.144	-0.131	-0.120	0.001	0.012	0.009
LVPWd	-0.195^⑤	-0.181^⑥	-0.150	-0.030	-0.017	0.039
LVEF	0.161	0.171^③	0.177^①	0.205^⑦	0.212^⑧	0.205^⑦
E/e	-0.018	-0.047	-0.043	0.018	-0.015	-0.010
e/a	0.136	0.139	0.140	0.059	0.051	0.038
TC	-0.006	-0.008	-0.023	0.359^④	0.339^⑨	0.330^⑩
TAG	-0.130	-0.136	-0.117	-0.103	-0.103	-0.073
HDL-Ch	0.199^⑪	0.197^⑧	0.148	0.037	0.047	0.001
LDL-Ch	-0.117	-0.105	-0.099	-0.377	-0.360^⑫	-0.345^⑧
HbA_1c	-0.158	-0.162	-0.193^⑬	-0.195	-0.198^⑭	-0.239^⑮

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