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
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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(Hb A1c)、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<20μg/min及GFR≥90 m L/(min·1.73 m~2)为A组,UAER<20μg/min及GFR<90 m L/(min·1.73 m2)为B组;UAER≥20μg/min及GFR≥90 m L/(min·1.73 m2)为C组,UAER≥20μg/min及GFR<90 m L/(min·1.73 m~2)为D组。分析各组相关指标的差异。对UAER正常组(<20μg/min)和异常组(≥20μg/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 m L/(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≥20μg/min时,较高UAER是心脏舒张功能降低的独立危险因素。
Objective To study the relationship between microalbuminuria and cardiac diastolic function in patientswith type 2 diabetes mellitus(T2DM) and nonalcoholic fatty liver disease(NAFLD). Methods A total of 262 patients withT2 DM 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), fastinginsulin level(FINS), insulin resistance index(HOMA- IR), glycosylated hemoglobin(Hb A1c), 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 accordingto data of UAER and GFR: group A[UAER<20 μg/min and GFR≥90 m L/(min·1.73 m~2)], group B [UAER<20 μg/min andGFR<90 m L/(min·1.73 m2)], group C [UAER≥20 μg/min and GFR≥90 m L/(min·1.73 m~2)], and group D [UAER≥20 μg/minand GFR<90 m L/(min·1.73 m~2)]. The differences between the relevant indicators were analyzed between groups. Logisticregression analysis was used to compare UAER between normal group and abnormal group. Also the relationship between therelated 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 ofnormal 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 LVWIshowed a increasing trend in order in four groups(P<0.05). Values of LFC were significantly higher in C and D groupscompared 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 m L(/min·1.73 m2)was an independent risk factor for cardiac diastolic function in normal group of UAER, andhigher 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 T2 DM and NAFLD and microalbuminuria. WhenUAER≥20 μg/min, the higher UAER is an independent risk factor for reducing diastolic cardiac dysfunction.
Objective To study the relationship between microalbuminuria and cardiac diastolic function in patientswith type 2 diabetes mellitus(T2DM) and nonalcoholic fatty liver disease(NAFLD). Methods A total of 262 patients withT2 DM 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), fastinginsulin level(FINS), insulin resistance index(HOMA- IR), glycosylated hemoglobin(Hb A1c), 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 accordingto data of UAER and GFR: group A[UAER<20 μg/min and GFR≥90 m L/(min·1.73 m~2)], group B [UAER<20 μg/min andGFR<90 m L/(min·1.73 m2)], group C [UAER≥20 μg/min and GFR≥90 m L/(min·1.73 m~2)], and group D [UAER≥20 μg/minand GFR<90 m L/(min·1.73 m~2)]. The differences between the relevant indicators were analyzed between groups. Logisticregression analysis was used to compare UAER between normal group and abnormal group. Also the relationship between therelated 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 ofnormal 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 LVWIshowed a increasing trend in order in four groups(P<0.05). Values of LFC were significantly higher in C and D groupscompared 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 m L(/min·1.73 m2)was an independent risk factor for cardiac diastolic function in normal group of UAER, andhigher 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 T2 DM and NAFLD and microalbuminuria. WhenUAER≥20 μg/min, the higher UAER is an independent risk factor for reducing diastolic cardiac dysfunction.
引文
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[3]Wang Y,Yuan A,Yu C.Correlation between microalbuminuria and cardiovascular events[J].Int J Clin Exp Med,2013,6(10):973-978.
[4]Thompson S,James M,Wiebe N,et al.Cause of Death in Patients with Reduced Kidney Function[J].J Am Soc Nephrol,2015,26(10):2504-2511.doi:10.1681/ASN.2014070714.
[5]Mikolasevic S,Racki V,Lukenda M.et al.Non-alcoholic fatty liver disease;a part of the metabolic syndrome in the renal transplant recipient and possible cause of an allograft dysfunction[J].Medical Hypotheses,2014,82(1):36-39.doi:10.1016/j.mehy.2013.10.030.
[6]Mikolasevic I,Racki S,Bubic I,et al.Chronic kidney disease and nonalcoholic Fatty liver disease proven by transient elastography[J].Kidney Blood Press Res,2013,37(4/5):305-310.doi:10.1159/000350158.
[7]Fargion S,Porzio M,Fracanzani AL.Nonalcoholic fatty liver disease and vascular disease:state-of-the-art[J].World JGastroenterol,2014,20:13306-13324.doi:10.3748/wjg.v20.i37.13306.
[8]Targher G,Byrne CD.Clinical Review:Nonalcoholic fatty liver disease:a novel cardiometabolic risk factor for type 2 diabetes and its complications[J].J Clin Endocrinol Metab,2013,98:483-495.doi:10.1210/jc.2012-3093.
[9]Orli?L,Mikolasevic I,Bagic Z,et al.Chronic kidney disease and nonalcoholic Fatty liver disease-is there a link[J].Gastroenterol Res Pract,2014,2014:847539.doi:10.1155/2014/847539.
[10]Stevens PE,Levin A,Kidney Disease:Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members.Evaluation and management of chronic kidney disease:synopsis of the kidney disease:improving global outcomes 2012clinical practice guideline[J].Ann Intern Med,2013,158(11):825-830.doi:10.7326/0003-4819-158-11-201306040-00007.
[11]Miura M,Sakata Y,Miyata S,et al.Prognostic impact of subclinical microalbminuria in patients with chronic heart failure:report from the CHART-2 study[J].Circ J,2014,78:2890-2898.
[12]Azzam H,Malnick L.Non-alcoholic fatty liver disease-the heart of the matter[J].World J Hepatol,2015,7(10):1369-1376.doi:10.4254/wjh.v7.i10.1369.2016-09-23 2016-11-16
[2]Mantovani A,Pernigo M,Bergamini C,et al.Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes[J].PLo S One,2015,10(8):e0135329.doi:10.1371/journal.pone.0135329.
[3]Wang Y,Yuan A,Yu C.Correlation between microalbuminuria and cardiovascular events[J].Int J Clin Exp Med,2013,6(10):973-978.
[4]Thompson S,James M,Wiebe N,et al.Cause of Death in Patients with Reduced Kidney Function[J].J Am Soc Nephrol,2015,26(10):2504-2511.doi:10.1681/ASN.2014070714.
[5]Mikolasevic S,Racki V,Lukenda M.et al.Non-alcoholic fatty liver disease;a part of the metabolic syndrome in the renal transplant recipient and possible cause of an allograft dysfunction[J].Medical Hypotheses,2014,82(1):36-39.doi:10.1016/j.mehy.2013.10.030.
[6]Mikolasevic I,Racki S,Bubic I,et al.Chronic kidney disease and nonalcoholic Fatty liver disease proven by transient elastography[J].Kidney Blood Press Res,2013,37(4/5):305-310.doi:10.1159/000350158.
[7]Fargion S,Porzio M,Fracanzani AL.Nonalcoholic fatty liver disease and vascular disease:state-of-the-art[J].World JGastroenterol,2014,20:13306-13324.doi:10.3748/wjg.v20.i37.13306.
[8]Targher G,Byrne CD.Clinical Review:Nonalcoholic fatty liver disease:a novel cardiometabolic risk factor for type 2 diabetes and its complications[J].J Clin Endocrinol Metab,2013,98:483-495.doi:10.1210/jc.2012-3093.
[9]Orli?L,Mikolasevic I,Bagic Z,et al.Chronic kidney disease and nonalcoholic Fatty liver disease-is there a link[J].Gastroenterol Res Pract,2014,2014:847539.doi:10.1155/2014/847539.
[10]Stevens PE,Levin A,Kidney Disease:Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members.Evaluation and management of chronic kidney disease:synopsis of the kidney disease:improving global outcomes 2012clinical practice guideline[J].Ann Intern Med,2013,158(11):825-830.doi:10.7326/0003-4819-158-11-201306040-00007.
[11]Miura M,Sakata Y,Miyata S,et al.Prognostic impact of subclinical microalbminuria in patients with chronic heart failure:report from the CHART-2 study[J].Circ J,2014,78:2890-2898.
[12]Azzam H,Malnick L.Non-alcoholic fatty liver disease-the heart of the matter[J].World J Hepatol,2015,7(10):1369-1376.doi:10.4254/wjh.v7.i10.1369.2016-09-23 2016-11-16