慢性心力衰竭和左心室射血分数降低患者的临床和仪器特征与II型糖尿病的关系

N. Tkach, O. L. Filatova, T. Gavrilenko, G. Dudnik, N. Lipkan, L. Voronkov
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引用次数: 0

摘要

目的是比较慢性心力衰竭(CHF)和左心室射血分数降低(LVEF)患者的临床和仪器参数,这些参数取决于II型糖尿病的存在。材料和方法。分析2011 - 2018年490例CHF患者的病史,年龄40 - 80岁(中位- 64岁),II-IV NYHA功能分级,LVEF≤40%。研究组主要包括冠心病合并高血压患者403例(82.2%),单独冠心病患者55例(11.2%),高血压患者32例(6.6%)。大多数患者(278例(56.7%))有永久性房颤。其中男性373人(76.1%),女性117人(23.9%)。研究中纳入的患者处于临床代偿期,即处于血液充血状态。所有患者分为两组:第一组包括338例(69%)无糖尿病的CHF和LVEF降低患者;II组包括152例(31%)伴有CHF和LVEF降低的II型糖尿病患者。结果和讨论。分析显示,研究组患者在年龄、一般血流动力学参数、平均每日心率、NYHA功能分级、合并慢性阻塞性肺疾病和CHF持续时间方面无显著差异。II组房颤患者的百分比较低,I组患者的BMI较高,未合并糖尿病的患者的左室心肌质量指数Е/´较高。在本研究中,我们发现伴有2型糖尿病的患者尿酸水平明显较高,氧化应激和促炎标志物、NT-proBNP和胰岛素水平无统计学差异。血流依赖性内皮功能障碍值也无显著差异。冠心病和糖尿病2型合并已被证明是CHF患者高死亡率的一个主要因素。然而,我们没有发现伴有和不伴有糖尿病的CHF和LVEF降低患者的预期寿命有差异。hba1r高于7.4%的患者生存率也明显较差。伴有和不伴有2型糖尿病的LVEF降低的CHF患者的5年生存率无显著差异,而在一般患者组中,hba1r高于7.4%的患者表现出最差的5年生存率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction depending on the presence of type II diabetes mellitus
The aim – to compare clinical and instrumental parameters in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) depending on the presence of type II diabetes mellitus.Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. The study group included mainly patients with coronary heart disease (CHD) in combination with hypertension – 403 (82.2 %) patients, with isolated CHD – 55 (11.2 %) and with hypertension – 32 (6.6 %) patients. Most patients (278 (56.7 %)) had a permanent form of atrial fibrillation. Among the subjects were 373 (76.1 %) men and 117 (23.9 %) women. Patients were included in the study in the phase of clinical compensation, i.e. in the euvolemic state. All patients were divided into two groups: group I included 338 (69 %) patients with CHF and reduced LVEF without diabetes; group II consisted of 152 (31 %) patients with CHF and reduced LVEF with type II diabetes.Results and discussion. The analysis revealed no significant differences among patients in the study groups by age, general hemodynamic parameters, mean daily heart rate, NYHA functional class, concomitant chronic obstructive pulmonary disease and the duration of CHF. A lower percentage of patients with atrial fibrillation in group II, a higher BMI in patients in group I, Е/е´ and left ventricular myocardial mass index were higher in patients without concomitant diabetes. In the study, we obtained a significantly higher uric acid level in patients with concomitant diabetes mellitus 2 and did not receive statistical differences in oxidative stress and proinflammatory markers, NT-proBNP and insulin. There was also no significant difference in the values ​​of flow-dependent endothelial dysfunction. The combination of coronary heart disease and diabetes mellitus 2 has been shown to be a major factor of high mortality in patients with CHF. However, we did not find a difference in the life expectancy of patients with CHF and reduced LVEF with and without diabetes. We also had a significantly worse survival of patients with HbA1с above 7.4 %.Conclusions. The 5-year survival of patients with CHF with reduced LVEF with and without diabetes mellitus 2 does not differ significantly, while among the general group of patients the worst 5-year survival was demonstrated by those with HbA1с higher than 7.4 %.
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