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学科主题: 内科学
题名:
反复低血糖对2型糖尿病患者心功能的影响
作者: 王占辉
答辩日期: 2014-05-22
导师: 刘彦君
专业: 内科学
授予单位: 北京大学
授予地点: 北京大学解放军306医院教学医院
学位: 硕士
关键词: 糖尿病 2型 反复低血糖 心功能 影响
其他题名: The influences of repeated hypoglycemia on the cardiac function of patients with T2DM
分类号: R587.1
摘要: 目的:通过对解放军306医院内分泌科2008年1月1日至2012年12月31日5年间分别以“2型糖尿病”及“反复低血糖”为第一诊断的住院患者的临床资料进行分析研究,以了解2型糖尿病并反复低血糖患者的临床特点,并初步探索反复低血糖对2型糖尿病患者心功能的影响。 方法:在解放军306医院电子病历系统中,检索2008年1月1日至2012年12月31日期间分别以“2型糖尿病”及“反复低血糖”为第一诊断且于内分泌科住院治疗的患者病案,收集到“2型糖尿病”为第一诊断病例1572例,“反复低血糖”为第一诊断病例74例。将1572例第一诊断“2型糖尿病”患者按年龄排序后进行系统抽样选取102例。查阅102例第一诊断“2型糖尿病”与74例第一诊断“反复低血糖”患者病案,依据制定的纳入、排除标准进行相应选取与剔除后,最终得到有效病例112例,其中,2型糖尿病且无低血糖发生组68例,2型糖尿病并反复低血糖组44例。逐例查阅病案并收集其住院期间人口学特征、一般临床资料及生化指标、糖尿病并发症及合并症、入院前降糖治疗方案、心肌酶谱及心脏超声检查结果等数据,采用spss17.0统计软件进行统计分析及探索。 结果:(1)一般临床资料方面,两组患者间性别构成、年龄、收缩压、舒张压的差异没有统计学意义,P值均≥0.05。而两组患者糖尿病病程(166.3±96.7(月)vs115.8±78.4(月))的差异具有显著性,P值<0.05。(2)生化指标方面,肝功指标中两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)差异不显著,而谷氨酰转肽酶(GT)(14(12~23)(IU/L)vs19(13~34)(IU/L), P值<0.05)差异有统计学意义。肾功指标中两组患者血尿素氮、白蛋白肌酐比差异没有统计学意义,而肌酐、血尿酸、肌酐清除率(66(45~80)(umol/L)vs60(48~69)(umol/L)、290±84(umol/L)vs256±80(umol/L)、94.5±36.9(ml/min)vs114.9±44.0(ml/min),P值均<0.05)差异显著。血糖控制水平及胰岛功能水平指标中两组患者空腹血糖、空腹胰岛素、空腹C肽、餐后C肽、稳态胰岛素抵抗指数差异没有统计学意义,而餐后2小时血糖、餐后胰岛素、糖化血红蛋白(10.13±4.39(mmol/L)vs12.06±4.82(mmol/L)、39.65(25.36~73.48)(uIu/ml)vs29.40(15.60~52.70)(uIu/ml)、8.2±1.8(%)vs9.0±2.0(%),P值均<0.05)则差异显著。炎症指标C反应蛋白(0.55(0.22~1.22)(mg/L)vs0.65(0.29~1.71)(mg/L),P值>0.05))两组间差异没有统计学意义。 (3)两组患者糖尿病合并症中,糖尿病周围神经病变、糖尿病肾病、糖尿病视网膜病变、周围动脉病变、糖尿病足患病率均没有显著差异。(4)两组患者降糖治疗中不同种类降糖药物使用率情况:两组患者间a糖苷酶抑制剂、磺脲类、胰岛素增敏剂、格列奈类、常规胰岛素、中效胰岛素、超速效胰岛素、超长效胰岛素使用率没有统计学差异,而反复低血糖组2型糖尿病患者双胍类降糖药使用率显著低于无低血糖2型糖尿病组患者(5例(11.4%)vs24例(35.3%),P值<0.05),预混胰岛素使用率则显著高于无低血糖2型糖尿病患者(22例(50%)vs15例(22.1%),P值<0.05)(5)心肌酶谱及心脏超声检查结果:心肌酶谱指标中两组患者间肌酸激酶、肌酸激酶同工酶差异没有统计学意义,而a羟丁酸脱氢酶、乳酸脱氢酶(138(120~150)(U/L)vs110(96~125)(U/L)、146±37(U/L)vs132±30(U/L),均P值<0.05)则2型糖尿病并反复低血糖组患者显著高于2型糖尿病无低血糖组患者。心脏超声结果中,心脏结构性指标中主动脉宽度、左房舒张末前后径、左室舒张末内径、室间隔厚度、左室后壁厚度两组患者间差异均没有统计学意义。心脏功能指标中舒张功能指标二尖瓣E/A、三尖瓣E/A两组间差异没有统计学意义,而收缩功能指标LVEF则2型糖尿病并反复低血糖组患者显著低于2型糖尿病无低血糖发生的患者(0.63±0.06vs0.66±0.05,P值<0.05)。(6)以左室射血分数为因变量,以性别、年龄、病程、心肌酶谱、心脏超声结果指标为自变量进行多元线性回归分析,并校正病程后,结果显示左室射血分数与反复低血糖呈负相关(β=0.032,t=2.978,p<0.05)。 结论:2型糖尿病并反复低血糖患者具有糖尿病病程较长、肾功能减低、血糖控制较严格、降糖治疗方案中二甲双胍使用率低、预混胰岛素使用率高等特点,提示具有这些特点的2型糖尿病患者是发生反复低血糖的高危险人群。与无低血糖发生的2型糖尿病患者相比,发生反复低血糖患者心脏左室、右室舒张功能没有显著差异,但左室射血分数减低有统计学意义,提示左室收缩功能显著减低。对于糖尿病病程较长、肾功能减低、血糖控制较严格的2型糖尿病患者,要慎重选择降糖药物,病程中密切关注其低血糖的发生,并定期检查其心功能,必要时及时处理,以降低2型糖尿病患者降糖治疗中低血糖发生的风险及其对机体的不利影响。
英文摘要: Objective:To find out the clinical features of diabetic patients with repeated hypoglycemia and preliminarily explore the effects of repeated hypoglycemia on cardiac function of patients with type 2 diabetes mellitus. Methods: We retrieved 1572 patients with “T2DM” as the first diagnosis and 74 patients with “Repeated hypoglycemia” as the first diagnosis in the PLA 306th Hospital electronic medical record system, and then selected 102 patients by systematic sampling from 1572 patients with “T2DM” as the first diagnosis after sorted by age .We checked up each patient′s medical records and selected out 68 diabetic patients without hypoglycemia(Group 2) and 44 diabetic patients with repeated hypoglycemia (Group 1)according to the formulated inclusion and exclusion criteria. Then we selected and analyzed the related clinical data of the 112 cases, and preliminarily explored the effects of hypoglycemia on cardiac function. Results: There is no significant difference between the gender age, systolic blood pressure(SBP) and diastolic blood pressure(DBP) of the two groups,but the diabetes duration of type 2 diabetic patients with repeated hypoglycemia is significantly longer than the other group(166.3±96.7(m)vs115.8±78.4(m), P<0.05). Among the biochemical indicators, the glutamyl transpeptidase(GT), creatinine clearance rate(CCr),postprandial blood glucose(PPG) and hemoglobin A1c( HbA1c) are significantly lower than the other group(14(12~23)(IU/L)vs19(13~34)(IU/L), 94.5±36.9(ml/min)vs114.9±44.0(ml/min), 10.13±4.39(mmol/L)vs12.06±4.82(mmol/L), 8.2±1.8(%)vs9.0±2.0(%),all the P<0.05), while the creatinine(Cr) , uric acid(UA) and postprandial insulin are significantly higher than the other group(66(45~80)(umol/L)vs60(48~69)(umol/L), 290±84(umol/L)vs256±80(umol/L), 39.65(25.36~73.48)(uIu/ml)vs29.40(15.60~52.70)(uIu/ml),all the P <0.05). There is no significant difference in the incidence of diabetic complications between the two groups. The usage of metformin in the type 2 diabetic patients with repeated hypoglycemia is significantly less than the other group(5(11.4%)vs24(35.3%),P<0.05)), while the usage of premixed insulin significantly more(22(50%)vs15(22.1%),P<0.05). Among the myocardial enzymes, both a-hydroxybutyric dehydrogenase(a-HBDH) and lactic dehydrogenase(LDH) of the type 2 diabetic patients with repeated hypoglycemia are significantly higher than the other group(138(120~150)(U/L)vs110(96~125)(U/L), 146±37(U/L)vs132±30(U/L),all the P<0.05). There is no significant difference in the mitral A/E between the two groups, while the left ventricular ejection fraction(LVEF) of type 2 diabetic patients with repeated hypoglycemia is significantly lower than the other group (0.63±0.06 vs0.66±0.05,P<0.05).Multiple linear regression analysis showed that repeated hypoglycemia was negatively related with EF(β=0.032,t=2.978,p<0.05). Conclusions: The type 2 diabetic patients with repeated hypoglycemia have longer diabetes duration, poorer kidney function, more stringent glucose control and higher usage of premixed insulin in the hypoglycemic therapy. The occurrence of repeated hypoglycemia in type 2 diabetic patients may reduce the cardiac systolic function.
语种: 中文
出处: http://xuewei.bjmu.edu.cn/simpsearch.action?keyword=反复低血糖对2型糖尿病患者心功能的影响&dbid=72
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/105444
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作者单位: 北京大学解放军306医院教学医院

Recommended Citation:
王占辉. 反复低血糖对2型糖尿病患者心功能的影响[D]. 北京大学解放军306医院教学医院. 北京大学. 2014.
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