cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2067Research ArticleСАХАРНЫЙ ДИАБЕТDIABETESИзменения структуры и функции левого желудочка сердца у больных сахарным диабетом 2 типа в зависимости от наличия кардиальной автономной нейропатии и компонентов метаболического синдромаChanges in left ventricular structure and function in Type 2 diabetic patients, depending on the presence of cardiac autonomic neuropathy and metabolic syndrome componentsЛунинаЕ. Ю.LuninaE. Yu.

ассистент кафедры общеврачебной практики и профилактической медицины с курсом основ доказательной медицины

Тверь, Тел.: (4822)-50–54–58; факс: (4822)-34–43–09

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leyu@mail.ruПетрухинИ. С.PetrukhinI. S.

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Тверь

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Тверская государственная медицинская академия Федерального агентства по здравоохранению и социальному развитиюTver State Medical Academy2011010119701087378Copyright © Лунина Е.Ю., Петрухин И.С., 19701970Лунина Е.Ю., Петрухин И.С.Lunina E.Y., Petrukhin I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2067

Цель. Оценить влияние кардиальной автономной нейропатии (КАН) на структурно-функциональные параметры левого желудочка (ЛЖ) сердца у больных сахарным диабетом 2 типа (СД-2) в зависимости от наличия у них компонентов метаболического синдрома (МС). Материалы и методы. Обследованы 157 больных (женщины – 128, мужчины – 29) с СД-2. МС определяли по критериям ВОЗ. КАН диагностировали при наличии ≥ 2 патологических результатов тестов Эвинга. Эхокардиографию выполняли в 4 группах больных: I (n=14) КАН- с не более 1 компонентом МС; II (n=16) КАН-, ≥2 компонента МС; III (n=19) КАН+, не более 1 компонента МС; IV (n=108) КАН+, ≥2 компонента МС. Тип геометрии левого желудочка (ЛЖ), систолическая и диастолическая его функции оценивались по общепринятым критериям. Результаты. Концентрическая гипертрофия ЛЖ (КГЛЖ) была наиболее частой геометрией ЛЖ у пациентов с КАН по сравнению с лицами без КАН – 62,2% и 20,0%, соответственно (p=0,02). Распространенность КГЛЖ оказалась максимальной при сочетании КАН с ≥2 компонентами МС (63,9%). > 50% пациентов с 0–1 компонентом МС и две трети пациентов с большим числом компонентов МС имели нарушение диастолической функции ЛЖ. При этом, если у первых наличие КАН не влияло на распространенность диастолической дисфункции, то у последних нарушение диастолической функции статистически значимо чаще встречалось в присутствии КАН – 90,7% среди КАН+ vs 56,2% среди КАН-, c ≥2 компонента МС (p=0,001). Заключение. КАН у больных СД-2 ассоциируется с КГЛЖ и его диастолической дисфункцией, причем указанная ассоциация усиливается с увеличением числа компонентов МС.

Aim. To assess the impact of cardiac autonomic neuropathy (CAP) on left ventricular (LV) structure and function in patients with Type 2 diabetes mellitus (DM-2), depending on the presence of metabolic syndrome (MS) components. Material and methods. The study included 157 patients (128 women and 29 men) with DM-2. MS was diagnosed according to WHO criteria. CAN was detected based on the standard Ewing test (≥2 positive results). M-mode, B-mode, and Doppler echocardiography was performed in 4 clinical groups: Group I (n=14): CAN-negative, ≤1 MS component; Group II (n=16): CAN-negative, ≥2 MS components; Group III (n=19): CAN-positive, ≤1 MS component; and Group IV (n=108): CAN-positive, ≥2 MS components. LV geometry type, as well as LV systolic and diastolic function, was assessed according to the standard criteria. Results. LV concentric hypertrophy (LVCH) was the most prevalent type of LV geometry in CAN-positive vs. CAN-negative patients (62,2% vs. 20,0%, respectively; p=0,02). The highest LVCH prevalence (63,9%) was registered in participants with CAN and ≥2 MS components. Over 50% of the patients with 0–1 MS component and two-thirds of the patients with ≥2 MS components had disturbed LV diastolic function. In the former, CAN presence did not affect the prevalence of diastolic dysfunction, while in the latter, diastolic dysfunction was significantly more prevalent among CAN-positive individuals (90,7%, compared to 56,2% in CAN-negative patients with ≥2 MS components; p=0,001). Conclusion. In DM-2 patients, CAN was associated with LVCH andLV diastolic dysfunction. This association strengthened, as the number of MS components increased.

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The authors declare that there are no conflicts of interest present.