·胰岛素抵抗及其相关疾病·

　　【摘要】目的 研究住院T2DM患者心脏功能和胰岛素抵抗(IR)的关系并明确影响其变化的危险因素。 方法 选择338例伴或不伴高血压病(EH)T2DM患者,应用心脏多普勒超声观察患者心脏结构及功能的变化，研究左室射血分数(LVEF)、二尖瓣心室充盈早期血流速度峰值(E峰)、晚期心室充盈心房收缩血流速度峰值(A峰)的比值(E/A)与患者的年龄、病程、BMI、HbA1C、TG、HDL-C、LDL-C及胰岛素抵抗指数(HOMA2-IR)间的相互关系和影响其变化的危险因素。结果 LVEF在伴或不伴EH患者间及不同EH分级间比较差异有统计学意义(P<0.01)。在无EH患者中，LVEF仅与(HOMA2-IR)相关(r=-1.898, P=0.028)。对于E/A值，年龄、EH、HOMA2-IR是其独立危险因素(OR分别为1.059、4.079、3.403，P均<0.01)。结论 IR可作为独立的影响因素作用于心脏功能的改变，IR患者存在心功能不全的危险倾向。

　　【关键词】糖尿病，2型;胰岛素抵抗;心脏功能;稳态模型评估法

　　Relationship between cardiac function and insulin resistance in T2DM patients YANG Ning, XU Yuan, ZHANG Dong-lei, et al. Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

　　Corresponding author: XU Yuan, E-mail: zdlzdl52973@sina.com

　　【Abstract】Objective To investigate the relationship between cardiac function and insulin resistance (IR), and find out risk factors for cardiac function in T2DM patients. Methods From November 2010 to April 2011, 338 T2DM patients with or without essential hypertension (EH) in our hospital were enrolled in this study. Doppler echocardiography was used to evaluate the change of cardiac structure and function. Left ventricular ejection fraction (LVEF), Mitral peak early diastolic transmitral flow velocity (E), mitral peak late diastolic transmitral flow velocity (A), E/A ratio were measured. Patients’ age and course of disease were recorded. The body mass index (BMI), glycosylated hemoglobin (HbA1C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and homeostasis model assessment 2-IR (HOMA2-IR) were measured to investigate the relationship of them with IR and find out risk factors for cardiac function in T2DM patients. Results Significant difference in LVEF was found in T2DM patients with or without EH and with EH in different degrees (P<0.01). In those without EH, LVEF was only correlated with HOMA2-IR (r=-1.898, P=0.028). As for E/A, the age, EH, and HOMA2-IR were the risk factors in T2DM patients (OR=1.059, 4.079, and 3.403 respectively, P<0.01). Conclusion IR could be an independent factor acting on the changes of the cardiac function. Patients with IR predispose to present cardiac functional insufficiency.

　　【Key words】Diabetes mellitus, type 2; Insulin resistance; Cardiac function; Homeostasis model assessment