糖尿病与心衰发生机制及诊疗现状.ppt

糖尿病与心力衰竭

—发生机制和诊疗进展南方医院心血管内科许顶立

美国心血管疾病发病率和

死亡原因百分比发病率心血管死因构成比AHA20010.5%0.5%50M12.4M4.5M1M4.7M1in5malesandfemaleshassomeformofcardiovasculardisease

心力衰竭的死亡率Framingham的研究（1948年～1988年）：有症状的心力衰竭患者，男性患者平均存活时间为3.2年，女性为5.4年。

心力衰竭的年发病率

病生机制和诊断重要进展心室重塑和心肌细胞凋亡是心力衰竭的重要病理生理机制，抑制心力衰竭时神经内分泌的过度激活是降低心力衰竭患者死亡率的重要方法。心导管检查和放射性核素心血管造影可以准确检测心脏收缩舒张功能，多谱勒超声心动图也是临床判断心脏收缩舒张功能简便和准确的方法，有床旁诊断价值。舒张性心力衰竭（DiastolicHeartFailure）为心力衰竭的一种特殊类型，是指各种疾病导致心室的舒张功能障碍但心室收缩功能尚正常而引发的临床综合征。目前的资料表明，充血性心力衰竭病人中约20-40%为单纯舒张性心力衰竭。

CoronaryarterydiseaseisthecauseofHFinabouttwothirdsofpatientswithleftventricularsystolicdysfunction.Theremainderhaveanonischemiccardiomyopathy,whichmayhaveanidentifiablecause(e.g.,hypertension,thyroiddisease,valvulardisease,alcoholuse,ormyocarditis)ormayhavenoknowncause(e.g.,idiopathicdilatedcardiomyopathy).

Diabetesistheleadingcauseofblindnessinpatientsaged20-74years.Diabetesisalsotheleadingcauseofend-stagerenaldisease.Approximately60-70%ofpatientswithdiabetesdevelopsomedegreeofneuropathy,includingerectiledysfunction.60-70%ofalldiabetes-relateddeathsareattributabletothemacrovascularmanifestationsofthedisease.Diabeticvasculardiseaseisresponsiblefora2-to4-foldincreaseintheincidenceofcoronaryheartdisease(CHD)andstrokeanda2-to8-foldincreaseintheriskforheartfailure.Diabeteshavea15-to40-foldincreasedriskforlowerextremityamputations.Pharmacotherapy2002,22(4):436-444.

During13,811person-yearsoffollow-up,173subjectsdevelopedincidentheartfailure,asconfirmedbychartreview.Fivefactorswereindependentpredictorsofheartfailure:malesex(RR=1.7;CI,1.3to2.4),olderage(RR=1.9;CI,1.3to2.7forage75to84years,RR=3.0;CI,1.7to5.5forage85yearsandolder,comparedwithor=74years),diabetes(RR=2.9;CI,2.0to4.3),pulsepressureor=70mmHg(RR=2.3;CI,1.3to4.3,comparedwith50mm