血管内皮生长因子与2型糖尿病肾病肾衰竭患者左心室舒张功能的关系

黄宇静; 伍锦泉; 黄佳丽

doi:10.3969/j.issn.1671-2390.2020.02.007

血管内皮生长因子与2型糖尿病肾病肾衰竭患者左心室舒张功能的关系

Relationship between plasma VEGF level and left ventricular diastolic function in type 2 diabetic renal failure patients

摘要

摘要: 目的分析2型糖尿病肾病（diabetic nephropathy，DN）肾衰竭患者左心室舒张功能与血管内皮生长因子的关系。方法本次研究分别选择30例门诊检查的健康患者与122例2型DN肾衰竭患者进行对比，以肾小球滤过率（eGFR）为标准将2型DN肾衰竭患者划分为慢性肾脏病（chronic kidney disease，CKD）3期组、CKD 4期组和CKD 5期组，以左心室舒张功能不全（left ventricular end diastolic dimension，LVDD）的诊断标准将患者分为LVDD组和非LVDD组。测量患者的左心室后壁厚度（left ventricular diastolic posterior wall thickness，LVPWT）、左室射血分数（EF）、左室舒张末内径（left ventricular end diastalic dimension，LVEDD）舒张早期最大血流速度E峰/舒张晚期A峰（E/A）、舒张末期室间厚度（interventricular septum thickness，IVST）、左室舒张末容积（left ventricular end diastolic volume，LVEDV）指标，判断患者左心室舒张功能与血管内皮生长因子水平之间的关联作用。结果与正常对照组相比，DN各期患者血管内皮生长因子（vascular endothelial growth factor，VEGF）水平含量均升高（P<0.05），随着患者肾功能进一步的衰竭，CKD3期、CKD4期和CKD5期患者的血VEGF水平含量逐渐升高（P<0.05）；LVDD组患者血浆VEGF水平高于非LVDD组（P<0.05）。与正常对照组相比，LVDD和非LVDD患者LVEDV水平均下降，IVST和LVPWT水平均升高，差异有统计学意义（P<0.05）。与非LVDD患者比较，LVDD患者LVEDV和E/A水平均下降，IVST和LVPWT水平升高，差异有统计学意义（P<0.05）。对于2型DN肾衰竭患者，血浆VEGF水平分别与LVPWT、IVST和LVEDD呈正相关（均P<0.05）。LVDD组患者VEGF分别与LVPWT、IVST和LVEDD呈正相关（均P<0.05）。结论血浆VEGF水平与2型DN肾衰竭患者左心室舒张功能密切相关，它可能在2型DN肾衰竭患者心血管事件的发生和发展发挥重要的作用，及早检测血浆VEGF水平有利于减少心血管并发症的发生。

Abstract: Objective To investigate the relationship between plasma VEGF level and left ventricular diastolic function in type 2 diabetic renal failurepatients. Methods Totally 122 cases of patients with type 2 DN renal failure were selected. In addition, 30 cases of healthy volunteers were taken as the control group. According to glomerular filtration rate (eGFR), the patients were divided into the CKD stage 3 group (CKD3 group, n=38), CKD stage 4 group (CKD4 group, n=47) and CKD stage 5 group (CKD5 group, n=37). On the basis of diagnostic criteria of left ventricular diastolic function (LVDD), patients were divided into the LVDD group and non-LVDD group. The levels of plasma VEGF level in each group were analyzed. Meanwhile, the left ventricular posterior wall thickness (LVPWT)、end-diastolic ventricular septal thickness (IVST)、left ventricular end-diastolic volume (LVEDV)、left ventricular ejection fraction(EF)、left ventricular end-diastolic dimension (LVEDD) and the early diastolic blood flow velocity E peak/diastolic late A peak (E/A) were measured. Then, we analyzed the correlation between plasma VEGF levels and left ventricular diastolic function. Results Compared with the control group, the levels of plasma VEGF of patients with various DN stages were all increased (P<0.05).With the aggravation of renal failure, the levels of VEGF in patients with CKD stage 3, CKD stage 4 and CKD stage 5 gradually increased. Plasma VEGF level in the LVDD group was higher than that in the non-LVDD group (P<0.05). Compared with the normal control group, LVEDV levels in LVDD and non-LVDD patients decreased, and IVST and LVPWT levels increased, with statistically significant differences (P<0.05). Compared with non-LVDD patients, LVEDV and E/A levels in LVDD patients were decreased, while IVST and LVPWT levels were increased, andthe differences were statistically significant. The plasma VEGF level hadpositive correlation with LVPWT、IVST and LVEDD in patients with type 2 DN renal failure (all P<0.05). The level of plasma VEGF level showed positive correlation with LVPWT, IVST and LVEDD of patients with LVDD group(all P<0.05). Conclusions Elevated levels of plasma VEGF in type 2 diabetic renal failure patients had a close relationship with left ventricular diastolic function, which may play a key role in the occurrence and progression of cardiovascular events, and early detection of plasma VEGF level is beneficial to reduce the incidence of cardiovascular complications.

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