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目的探讨代谢综合征(MS)患者心脏损害特点、脂肪因子的变化及其对左室收缩和舒张功能的影响。方法选择MS患者48例,正常对照组49例。应用组织多普勒成像技术测量二尖瓣瓣环整体运动速度指标,二尖瓣瓣环收缩期峰值运动速度(Sm)、二尖瓣瓣环舒张早期峰值运动速度(Em)、二尖瓣瓣环舒张晚期峰值运动速度(Am),采用实时荧光定量RT-PCR技术检测单个核细胞中瘦素受体和胃饥素的mRNA表达。结果与正常对照组比较,MS组患者舒张晚期A波流速峰值(A)显著升高,舒张早期E波流速峰值与舒张晚期A波流速峰值比值(E/A)、Sm、Em、Em/Am显著减低(P<0.01～0.001);外周血单核细胞瘦素受体和胃饥素的mRNA表达均显著减低(P均<0.05)。相关性分析显示,瘦素受体mRNA表达与A、E/A、Sm、Em、Em/Am显著相关(P<0.05);胃饥素mRNA表达与Em和Sm显著相关(P<0.05～0.01);进一步多元线性回归分析显示,E/A与瘦素受体mRNA表达具有数量依存关系,提示MS患者瘦素受体mRNA表达下调是心脏舒张功能减低的独立影响因素;多元线性回归分析显示,Sm与胃饥素mRNA表达具有数量依存关系,提示胃饥素mRNA表达下调是左室早期收缩功能异常的独立影响因素。结论瘦素受体和胃饥素mRNA表达下降可能是MS患者左室功能异常的机制之一。
Objective To investigate the characteristics of cardiac damage, the changes of adipokines and their effects on left ventricular systolic and diastolic function in patients with metabolic syndrome (MS). Methods 48 cases of MS patients were selected, 49 cases of normal control group. Tissue Doppler imaging was used to measure mitral annulus velocity, mitral annular peak systolic velocity (Sm), mitral annular early diastolic peak velocity (Em), mitral valve The peak diastolic peak velocity (Am) was measured by real-time fluorescent quantitative RT-PCR. The mRNA expression of leptin receptor and ghrelin in mononuclear cells was detected by real-time fluorescent quantitative RT-PCR. Results Compared with the normal control group, the peak value of A wave in late diastolic phase was significantly increased in MS group. The peak E wave velocity (A / E), Sm, Em, Em / Am (P <0.01 ~ 0.001). The mRNA expression of leptin receptor and gastrin in peripheral blood mononuclear cells were significantly decreased (all P <0.05). Correlation analysis showed that the expression of leptin receptor mRNA was significantly correlated with A, E / A, Sm, Em, Em / Am (P <0.05) ). Further multivariate linear regression analysis showed that there was a quantitative relationship between E / A and leptin receptor mRNA expression, suggesting that downregulation of leptin receptor mRNA expression in MS patients was an independent predictor of cardiac diastolic function. Multivariate linear regression analysis showed that, Sm and gastrin mRNA expression in a quantitative relationship, suggesting that downregulation of gastrin mRNA expression is an independent factor of early left ventricular systolic dysfunction. Conclusion The decreased expression of leptin receptor and ghrelin mRNA may be one of the mechanisms of left ventricular dysfunction in MS patients.