摘要
目的研究不同血压分级的2型糖尿病患者血清神经肽Y(neuropetide Y,NPY)的差异,分析其与左心结构和功能的关系。方法收集2015年9月-2017年1月于保定市第一中心医院住院的2型糖尿病患者165例,包括单纯糖尿病患者(DM组)40例和2型糖尿病合并高血压患者125例[依据血压水平又分为糖尿病高血压1级组(DH1组,40例),糖尿病高血压2级组(DH2组,41例),糖尿病高血压3级组(DH3组,44例)],选取同期体检健康者35例作为对照组(NS组),检测血清NPY的含量,并测量受试者超声心动图参数,包括室间隔厚度(interventricular septal thickness,IVST)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、左心房内径(left atrial diameter,LAD)、左心室质量指数(left ventricular mass index,LVMI)、左心室射血分数(left ventricular ejection fraction,LVEF)、二尖瓣口舒张早期及舒张晚期血流峰值速度比值(E/A),对比受试者之间各项指标的差异,并分析其相关性。结果总体上,DM组及糖尿病合并高血压组(DH1组、DH2组和DH3组)的超声心动图指标与NS组差异显著(P均<0.05);DM组、DH1组、DH2组和DH3组间比较显示:随着血压分级的增加,IVST、LVEDD、LVPWT、LAD、LVMI、NPY呈现逐渐升高的趋势,而LVEF、E/A逐渐降低,但仅有DH3组各项指标与其他三组均有显著差异[DH3组vs DH1和DH2组:IVST(11.71±0.82 mm vs 10.66±1.06 mm,9.89±0.93 mm),LVEDD(49.36±2.14 mm vs 44.67±2.99 mm,41.86±2.89 mm),LVPWT(10.02±0.85 mm vs 8.86±0.85 mm,6.9±0.92 mm),LVMI(136.96±11.17 g/m^2 vs 70.68±14.35 g/m^2,64.10±8.46 g/m^2)和NPY(15.53±4.35 ng/L vs 10.56±3.64 ng/L,8.67±3.52 ng/L),LVEF(60.97%±6.70%vs67.62%±3.24%,70.71%±5.17%)和E/A(0.50±0.09 vs 1.07±0.32,1.33±0.45)(P均<0.05)]。DH2组和DH3组LAD(分别为31.06±2.55 mm和29.91±1.82 mm)均显著低于DH1组(36.10±3.02 mm)(P<0.05),但前两组之间差异无统计学意义。回归分析结果显示LVMI是NPY的独立危险因素且呈正相关(r=0.57,P=0.000)。结论随着血压分级的增高,2型糖尿病患者左心肥厚程度增加,左心收缩功能降低,血清NPY含量逐渐升高。
Objective To study the changes of serum neuropeptide Y（NPY） and its correlation with left heart morphology and function in patients with type 2 diabetes at different blood pressure levels. Methods One hundred and sixty five type 2 diabetes patients, including 40 type 2 diabetes patients（DM group） and 125 type 2 diabetes patients with hypertension（DH1 group, n=40; DH2 group, n=41; DH3 group, n=44）, 35 healthy people as NS group were enrolled in this study. The serum NPY level was detected by ELISA. Echocardiographic parameters including interventricular septal thickness（IVST）, left ventricular end-diastolic diameter（LVEDD）, left ventricular posterior wall thickness（LVPWT）, left atrial diameter（LAD）, and left ventricular ejection fraction（LVEF） were measured, then left ventricular mass index（LVMI） and E/A were calculated. The differences in all the indicators were compared between each group. Results There were significant differences in echocardiographic parameters between NS group and diabetes groups（DM group, DH1 group, DH2 group and DH3 group）（all P〈0.05）. With increasing of hypertension grade, the levels of IVST, LVEDD, LVPWT, LAD, l LVMI and NPY in DM, DH1, DH2 and DH3 groups increased, and LVEF, E/A decreased gradually. However, among DH groups, only the differences between DH3 group and other 2 groups were significant. Echocardiographic parameters in DH3 group, DH2 group and DH1 group were as follows, IVST（11.71±0.82 mm vs 10.66±1.06 mm, 9.89±0.93 mm）; LVEDD（49.36±2.14 mm vs 44.67±2.99 mm, 41.86±2.89 mm）; LVPWT（10.02±0.85 mm vs 8.86±0.85 mm, 6.9±0.92 mm）; LVMI（136.96±11.17 g/m^2 vs 70.68±14.35 g/m^2, 64.10±8.46 g/m^2）; NPY：（15.53±4.35 ng/L vs 10.56±3.64 ng/L, 8.67±3.52 ng/L）, LVEF（60.97%±6.70% vs 67.62%±3.24%, 70.71%±5.17%） and E/A（0.50±0.09 vs 1.07±0.32, 1.33±0.45）（all P〈0.05）. LAD in DH2 group and DH3 group were 31.06±2.55 mm and 29.91±1.82 mm, which were significantly lower than that in DH1 group（36.10±3.02 mm）（P〈0.05）. Further multiple regression analysis showed that LVMI was independently correlated with the level of NPY（r=0.57, P=0.000）. Conclusion With the rising of blood pressure, the left ventricular systolic function decreases, while left ventricular hypertrophy progresses, so does the levels of serum NPY. NPY may play an important role in the changes of left heart morphology and function in diabetes patients with hypertension.
出处
《解放军医学院学报》
CAS
2017年第11期999-1003,共5页
Academic Journal of Chinese PLA Medical School
基金
国家自然科学基金青年基金项目(81500644)
河北省医学科学研究课题计划(20160282)
保定市科学技术研究与发展计划(16ZF071)~~
关键词
2型糖尿病
高血压
神经肽Y
左心功能
type 2 diabetes mellitus
hypertension
neuropetide Y
left ventricular function
作者简介
李宝新，男，博士，主治医师。研究方向：内分泌与代谢病。Email：lbxlcx@163．com;通信作者：张云良，男，学士，主任医师，硕士生导师。Email：nfmzyl@163．com
