肢端肥大症合并高血压、糖代谢异常患者的心脏超声改变研究

Echocardiographic changes in patients with acromegaly with hypertension and abnormal glucose metabolism

摘要:

目的 探讨肢端肥大症合并高血压、糖代谢异常患者的超声心动图改变。方法 回顾性收集2016年4月至2021年8月在陆军军医大学第二附属医院确诊的肢端肥大症患者120例，根据是否合并高血压和（或）糖代谢异常分为A组（无合并高血压和糖代谢异常），B组（仅合并糖代谢异常），C组（仅合并高血压）和D组（同时合并高血压及糖代谢异常），比较各组超声心动图参数的差异，以分析肢端肥大症患者合并症对心脏结构及功能的影响。结果 各组右心超声参数差异无统计学意义；左心超声参数结果显示：D组左心室质量指数、室间隔厚度明显高于A组、B组，二尖瓣口舒张充盈早期与晚期峰值速度比值（E/A）明显低于A组、B组，差异有统计学意义（P<0.05）。D组发生左心室肥厚、左心房扩大、左心室E/A比值异常的概率更高（OR=3.40，P=0.005；OR=4.14，P=0.009；OR=5.95，P<0.001）。结论 通过超声心动图能敏感发现且准确评估肢端肥大症合并高血压和（或）糖代谢异常的心脏改变。

Abstract:

Objective To investigate the echocardiographic changes in patients with acromegaly with hypertension and abnormal glucose metabolism.Methods We retrospectively included 120 patients with acromegaly diagnosed in The Second Affiliated Hospital of Army Medical University from April 2016 to August 2021. According to the presence or absence of hypertension and/or abnormal glucose metabolism，the patients were divided into group A（without hypertension or abnormal glucose metabolism），group B（with only abnormal glucose metabolism），group C（with only hypertension），and group D（with both hypertension and abnormal glucose metabolism）. We compared the echocardiographic parameters of the groups，and analyzed the influence of comorbidities on the structure and function of the heart in patients with acromegaly.Results There were no significant differences in the echocardiographic parameters of the right heart between the groups. The results of left heart echocardiogphic parameters showed that the left ventricular mass index and interventricular septal thickness of group D were significantly higher than groups A and B， and mitral ratio of peak early and late diastolic filling velocity （E/A） was significantly lower than groups A and B（P<0.05）. Group D had significantly higher probabilities of left ventricular hypertrophy，left atrial enlargement，and an abnormal left ventricular E/A ratio（odds ratio ［OR］=3.40，P=0.005；OR=4.14，P=0.009；OR=5.95，P<0.001）.Conclusion Echocardiography can sensitively detect and accurately evaluate cardiac changes in patients with acromegaly with hypertension and/or abnormal glucose metabolism.