糖尿病患者肺部微血管疾病的诊断及意义

本文由“罂粟花”授权转载

翻译：安丽  编辑：冯玉蓉  审校：曹莹

目的：使用一种新的超声心动图标记——激动造影剂气泡(PTAC)，来量化肺部气-血转运，以明确是否可在糖尿病患者中检测到肺微血管疾病，并与运动能力下降有关。

研究设计与方法：60名受试者（40名糖尿病患者和20名对照受试者）在1周内进行了心肺功能（最大耗氧量[VO2peak]）和半仰卧脚踏车超声心动图运动试验。采用PTAC（经过肺循环到达左心室的气泡数，分为低PTAC或高PTAC）的方法来评估肺微血管疾病。在运动过程中，运用超声心动图测量心输出量、肺动脉压和双心室功能。

结果：在高强度运动时，与对照组相比，糖尿病患者中PTAC水平较低的人数更多(41% vs. 12.5%, χ² P = 0.041)，尤其是与无并发症的糖尿病患者和对照组相比，有微血管并发症的糖尿病患者PTAC水平较低的人数更多 (55% vs. 26% vs. 13%, χ² P = 0.02)。糖尿病患者和对照组的年龄(44 ±13 vs. 43 ±13岁, P = 0.87) 和性别(70% vs. 65%男性, P = 0.7)组成相似。与高PTAC相比，低PTAC与运动期间VO₂peak降低24% (P = 0.006)、右心室功能降低(P = 0.015)和肺动脉压增大 (P = 0.02)有关。

结论：糖尿病患者的PTAC降低，特别是在其他血管床微血管病变的情况下，提示PTAC可能是肺微血管疾病的一个有意义的指标，对心血管功能和运动能力有重要影响。

原始文献：Roberts TJ, Burns AT, MacIsaac RJ, et al. Diagnosis and Significance of Pulmonary Microvascular Disease in Diabetes.[J].Diabetes Care 2018 04;41(4):854-861.

Diagnosis and Significance of Pulmonary Microvascular Disease in Diabetes

Abstract

OBJECTIVE

To determine whether pulmonary microvascular disease is detectable in subjects with diabetes and associated with diminished exercise capacity using a novel echocardiographic marker quantifying the pulmonary transit of agitated contrast bubbles (PTAC).

RESEARCH DESIGN AND METHODS

Sixty participants (40 with diabetes and 20 control subjects) performed cardiopul-monary (maximal oxygen consumption [VO₂peak]) and semisupine bicycle echocar-diography exercise tests within a 1-week period. Pulmonary microvascular disease was assessed using PTAC (the number of bubbles traversing the pulmonary circulation to reach the left ventricle, categorized as low PTAC or high PTAC). Echocardiographic measures of cardiac output, pulmonary artery pressures, and biventricular function were obtained during exercise.

RESULTS

At peak exercise, low PTAC was present in more participants with diabetes than control subjects (41% vs. 12.5%, χ² P = 0.041) and, in particular, in more subjects with diabetes with microvascular complications compared with both those without complications and control subjects (55% vs. 26% vs. 13%, χ² P = 0.02).Subjects with diabetes and control subjects were of similar age (44 ±13 vs. 43 ±13 years, P = 0.87) and sex composition (70% vs. 65% male, P = 0.7).When compared with high PTAC, low PTAC was associated with a 24% lower VO₂peak (P = 0.006), reduced right ventricular function (P = 0.015), and greater pulmonary artery pressures during exercise (P = 0.02).

CONCLUSIONS

PTAC is reduced in diabetes, particularly in the presence of microvascular pathology in other vascular beds, suggesting that it may be a meaningful indicator of pulmonary microvascular disease with important consequences for cardiovascular function and exercise capacity.