2021 年第 12 期 第 16 卷

老年射血分数保留的心力衰竭患者心功能与胰岛素抵抗的相关性研究

Relationship between cardiac function and insulin resistance in elderly patients with heart failure with preserved ejection fraction

作者：杨跃光1韩宇博2邹国良2刘莉2

英文作者：Yang Yueguang1 Han Yubo2 Zou Guoliang2 Liu Li2

单位：1黑龙江中医药大学研究生院，哈尔滨150040；2黑龙江中医药大学附属第一医院心血管科，哈尔滨150040

英文单位：1Graduate School of Heilongjiang University of Chinese Medicine Harbin 150040 China; 2Department of Cardiovascular Medicine First Affiliated Hospital Heilongjiang University of Chinese Medicine Harbin 150040 China

关键词：

英文关键词：射血分数；心力衰竭；胰岛素抵抗；心功能

• 摘要：

• 目的 探讨老年射血分数保留的心力衰竭(HFpEF)患者心功能与胰岛素抵抗的相关性。方法 选择2018年12月至2019年12月于黑龙江中医药大学附属第一医院心血管一科就诊的老年HFpEF患者60例为HFpEF组。选择同期医院体检心功能正常者60例作为对照组。比较2组空腹胰岛素、空腹血糖、稳态模型评估胰岛素抵抗指数（HOMA-IR）、N末端B型脑钠肽前体（NT-proBNP）水平，超声心动图指标，并分析HFpEF患者HOMA-IR与纽约心脏病协会（NYHA）心功能分级、NT-proBNP、超声心动图指标的相关性。结果  HFpEF组患者空腹胰岛素、空腹血糖、HOMA-IR、NT-proBNP水平均明显高于对照组［（9.4±1.6）mIU/L比（7.7±2.4）mIU/L、（7.5±2.1）mmol/L比（5.8±1.0）mmol/L、（3.2±1.2）比（2.0±0.9）、（649±193）ng/L比（195±69）ng/L］，差异均有统计学意义（均P＜0.05）。HFpEF组患者左心房内径（LAD）、左心房容积指数（LAVI）明显高于对照组，舒张早期二尖瓣血流峰值/舒张晚期二尖瓣血流峰值(E/A)比值明显低于对照组（均P＜0.05）。老年HFpEF患者HOMA-IR与NYHA心功能分级、NT-proBNP、LAD、LAVI呈正相关（r=0.785、0.601、0.501、0.447，均P＜0.001），与E/A比值呈负相关（r=-0.868，P＜0.001）。结论  老年HFpEF患者的HOMA-IR显著高于正常水平，且与NYHA心功能分级呈正相关，积极改善老年HFpEF患者胰岛素抵抗有重要意义。

• Objective To investigate the relationship between cardiac function and insulin resistance in elderly patients with heart failure with preserved ejection fraction(HFpEF). Methods From December 2018 to December 2019, 60 patients with HFpEF admitted to the First Department of Cardiovascular Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine were selected as the HFpEF group. At the same time, 60 people with normal cardiac function undergone physical examination in the hospital were selected as the control group. Fasting insulin, fasting blood glucose, homeostasis model assessment of insulin resistance index (HOMA-IR), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and echocardiographic indexes were compared between the two groups. The correlation of HOMA-IR with New York Heart Association (NYHA) cardiac function classification, NT-proBNP and echocardiography in HFpEF patients were analyzed. Results Fasting insulin, fasting blood glucose, HOMA-IR and NT-proBNP levels in HFpEF group were significantly higher than those in control group［（9.4±1.6）mIU/L vs （7.7±2.4）mIU/L, （7.5±2.1）mmol/L vs （5.8±1.0）mmol/L, （3.2±1.2） vs （2.0±0.9）, （649±193）ng/L vs （195±69）ng/L］（all P＜0.05）. The left atrial diameter (LAD) and left atrial volume index (LAVI) in HFpEF group were significantly higher than those in control group, and the ratio of peak value of mitral early diastolic blood flow to peak value of mitral late diastolic blood flow (E/A) in HFpEF group was significantly lower than that in control group (all P＜0.05). HOMA-IR was positively correlated with NYHA cardiac function classification, NT-proBNP, LAD and LAVI in elderly patients with HFpEF(r=0.785, 0.601, 0.501, 0.447, all P＜0.001), and negatively correlated with E/A(r=-0.868, P＜0.001). Conclusions   The level of HOMA-IR in elderly patients with HFpEF is significantly higher than the normal level, and it is positively correlated with NYHA cardiac function classification. It is important to actively improve insulin resistance in elderly patients with HFpEF.