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Diabetes Care:高血糖对南亚人左心室功能影响更大

2013-12-09 佚名 丁香园

糖尿病与左心室舒张和收缩功能有关。由于糖尿病患病率较高,南亚人处于发生LV功能障碍的特定风险中。为此,来自英国国家心肺研究所的Park博士等以老年南亚人和欧洲白人为研究对象,对糖尿病和高血糖在LV功能障碍中的作用进行了研究,发现糖尿病和高血糖对南亚人LV功能的不良影响比对欧洲人的大,这种差异不能完全由不良危险因素的不同来解释。研究结果在线发表于2013年11月15日的美国《

糖尿病与左心室舒张和收缩功能有关。由于糖尿病患病率较高,南亚人处于发生LV功能障碍的特定风险中。为此,来自英国国家心肺研究所的Park博士等以老年南亚人和欧洲白人为研究对象,对糖尿病和高血糖在LV功能障碍中的作用进行了研究,发现糖尿病和高血糖对南亚人LV功能的不良影响比对欧洲人的大,这种差异不能完全由不良危险因素的不同来解释。研究结果在线发表于2013年11月15日的美国《糖尿病治疗》(Diabetes Care)杂志上。

这是一项以人口为基础的研究,研究人员对999名参与者进行了常规和多普勒超声心动图检查。测定人体测量学、空腹血样、冠状动脉钙化评分、血压和肾功能。

结果显示,糖尿病、高血糖(包括一系列HbA1c)对南亚人LV功能的不良影响比对欧洲人的大。两组人群的HbA1c与LV功能指标的相关性分别为:N末端脑钠肽前体:0.09±0.04, p=0.01比-0.04±0.05, p=0.4,HbA1c/种族相互作用P值0.02;舒张功能(E/e'):0.69±0.12, p<0.0001比0.09±0.2, p=0.6, 相互作用P值0.005;收缩功能(s'):-0.11±0.06, p=0.04比0.14±0.09, p=0.1, 相互作用P值0.2.经高血压、微血管疾病、LV质量、冠状动脉疾病和血脂障碍校正后,仅能部分解释种族差异。不良血糖控制和较长的糖尿病病程不能解释南亚糖尿病患者不利的LV功能。

研究表明,糖尿病和高血糖对南亚人LV功能的不良影响比对欧洲人的大,这种差异不能完全由不同的不良危险因素解释。南亚人可能需要更早的、更激进的治疗心脏代谢危险因素的疗法,以减少LV功能障碍风险。

研究背景:糖尿病是心血管疾病和心衰的主要危险因素,随着糖尿病患病率和人口老龄化,它变得日益重要。但是,对于是否存在着不同类型的糖尿病心肌病是有争议的,特别是高血糖引起的心肌病。由于少数民族群体的危险因素显著不同,对该群体的研究大大有助于了解调控糖尿病与左心室功能相关性的潜在机制。

世界各地的南亚人糖尿病风险大量升高。与欧洲血统的人比较,南亚人糖尿病患病率升高4倍; 80岁的南亚人有50%将会发生糖尿病,而欧洲人的发病率仅为20%.作者在先前的研究中报道,糖尿病增加南亚人中风和缺血性心脏疾病风险的程度比欧洲人大,原因不清楚。糖尿病是否也对南亚人左心室(LV)功能和心衰风险产生更为不利的影响也尚不清楚。

目前还没有对心衰(HF)的相对风险进行直接测定,但是在南亚人中这一风险应该多达5倍高。越来越多的证据表明,HF存活率、严重性和病因也由于种族的不同而不同。LV收缩功能障碍(LVSD)和舒张功能障碍(LVDD)是HF发生和心源性死亡的独立危险因素。中年人很少发生心衰,但是,随着年龄增长和人口老龄化而逐渐出现。研究与亚临床疾病有关的危险因素将可能揭示潜在的发病风险和机制,同时能避免药物治疗心衰时所遇到的问题,改变结局的性质。

已有研究报道LV功能障碍的患病率和严重性存在着种族差异。但是,这些研究报道均来自对经过筛选的人群的研究,这类人群有明确的疾病,或是研究剔除了所有的死亡率。因此不能完全阐明糖尿病和高血糖在解释心衰发病风险存在种族差异中的作用。鉴于南亚人升高的糖尿病发病率和不良心血管疾病(CVD)危险因素,因此,先前那些排除已有CVD危险因素个人的研究可能会导致结果偏倚。

因此,该项研究假设:糖尿病和高血糖与左心室功能障碍指标有关,这种相关性因种族不同而不同,并对这一假设进行检测。此外,研究人员试图明确已知的危险因素是否可以解释这种相关性间的种族差异。

原始出处:

Park CM, Tillin T, March K, Ghosh AK, Jones S, Wright A, Heasman J, Francis D, Sattar N, Mayet J, Chaturvedi N, Hughes AD.Hyperglycaemia Has A Greater Impact On Left Ventricle Function In South Asians Than Europeans.Diabetes Care. 2013 Nov 15

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    2013-12-11 hbwxf
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