扩张型心肌病患者糖尿病与心肌胶原蛋白积聚和舒张受损的关系

Association of diabetes mellitus with myocardial collagen accumulation and relaxation impairment in patients with dilated cardiomyopathy

扩张型心肌病患者糖尿病与心肌胶原蛋白积聚和舒张受损的关系

Aims海南医学院附属医院内分泌科王新军

To assess the effects of diabetes mellitus (DM) on myocardial collagen accumulation, myocardial relaxation, and prognosis in patients with dilated cardiomyopathy (DCM).

目的
评估在扩张型心肌病（DCM）患者，糖尿病（DM）对心肌胶原积聚、心肌舒张和预后的影响。

 Methods

A total of 102 consecutive DCM patients with a New York Heart Association functional class of I or II were enrolled. Patients were allocated to two groups on the basis of the presence (DCM + DM group, n = 30) or absence (DCM − DM group, n = 72) of DM. Cardiac catheterization performed and left ventricular pressure were measured in all patients. The pressure half-time (T_1/2) was determined as an index of myocardial relaxation function. Endomyocardial specimens were subjected to histological analysis.

方法
共102 例纽约心脏协会功能分级为I类或II类的DCM患者参加本研究。根据患者是否存在糖尿病被分为两组：DCM +DM组，n = 30；DCM - 糖尿病组，n = 72。所有患者进行心导管检查和左心室压力测定。心肌舒张功能指标为压差半降时间（T1 / 2）。对心内膜标本进行组织学分析。 

Results

The T_1/2 was significantly longer (P < 0.001) and the collagen volume fraction was significantly greater (P = 0.018) in the DCM + DM group than in the DCM − DM group. Multivariate analysis showed that DM was significantly associated with increased incidence of cardiac events (hazard ratio, 3.7; 95% confidence interval, 1.05 to 13.16; P = 0.03).

结果
与DCM − DM组相比，DCM + DM组患者的T1 / 2显着延长（P< 0.001），胶原容积分数显著增加（P = 0.018）。多因素分析显示，糖尿病与心脏事件发生率增加有显著关系（风险比，3.7;  95％可信区间为1.05~13.16; P=0.03）。

Conclusions

The prognosis of DCM patients with DM was worse than that of those without DM. Impairment of myocardial relaxation, increased myocardial fibrosis, and mitochondrial degeneration associated with DM may underlie this difference.

结论
与无糖尿病的患者相比，DCM合并DM的患者预后较差。与糖尿病相关的心肌舒张受损、心肌纤维化增加、线粒体变性或许可以解释这种差异。

Diabetes Res Clin Pract. 2011 Mar 15.