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Purpose: diabetes, heart disease (diabetic heart disease) is one of the leading cause of death for diabetes, including coronary atherosclerotic heart disease, diabetic cardiomyopathy and diabetic cardiac autonomic neuropathy. Coronary atherosclerotic heart disease, coronary heart disease, has been well-known for clinical. Diabetic cardiomyopathy (Diabetic cardiomyopathy, DCM) is one of the major microvascular complications of diabetes (Diabetic DM). The pathogenesis of diabetic cardiomyopathy and myocardial metabolic disorders (abnormal supply and utilization of energy substrates, hyperinsulinemia and insulin resistance), changes in cardiac electrophysiology, endothelial cell dysfunction and microvascular disease (inflammatory response and oxidative stress, renal the hormone angiotensin system activation) and cardiac autonomic neuropathy. Obese T2DM risk groups, the release of a large number of non-esterified fatty acids, glycerol, fat-derived cytokines (such as leptin, fat, adiponectin, resistin, retinol-binding protein), inflammation in obesity, adipose tissue cytokines (such as transforming growth factor alpha, interleukin-6, monocyte chemoattractant protein-1, etc.) involved in insulin resistance. Overweight or obese increase the hemodynamic burden, activation of the sympathetic activity, increased oxidative stress and inflammatory response, the accumulation of fat in fat toxicity caused by myocardial damage. Fat secretion of cytokines imbalance or dysfunction plays an important role in the pathophysiology of insulin resistance and cardiovascular disease process, the middle part of the insulin resistance and heart disease may be considered. Adiponectin (Adiponectin, APN) is only discovered in recent years has a protective effect of adipose-derived cytokines, APN can directly regulate the activation of adenylate protein kinase pathway in vitro and in vivo glucose and lipid metabolism and insulin sensitivity, and enhance ability of insulin to regulate blood sugar, thus reducing the blood glucose level is a contact potential role of insulin for glucose and lipid metabolism promoting agent. APN has a change of myocardial oxidative stress, reduce myocardial fibrosis and improved cardiac function, is a protective factor in diabetic heart disease. The retinol binding protein 4 (Retinol-binding protein 4, RBP4) fat cells as a new factor, insulin signaling plays an important role. RBP4 levels, making IRS1 tyrosine phosphorylation decreased PI3K activity decreased, leading to insulin receptor signal transduction damaged. RBP4 can reduce the expression of GLUT4 affect the liver, muscle tissue glucose utilization, while accelerating adipose tissue lipolysis, resulting in glucose and lipid metabolism disorders. Many studies have shown that RBP4 and insulin resistance is closely related to obesity, especially abdominal obesity, serum RBP4 levels were significantly increased, increase RBP4mRNA expression. Echocardiography is the most commonly used clinical method for the evaluation of type 2 diabetic patients with cardiac structure and function. Structurally, the glycoprotein, collagen fiber, cholesterol deposition and myocardial interstitial inflammatory cell infiltration and fibrosis can cause left ventricular hypertrophy, ventricular weight gain changed. Echocardiography for myocardial thickness varies echo uneven, myocardial density enhancement. Diastolic function change is mainly manifested in the early diastolic blood flow velocity is reduced, increased late diastolic blood flow velocity, isovolumic relaxation extend, left ventricular end-diastolic pressure, end-diastolic diameter increases, the mitral valve open at a slower pace and open insufficiency, flaccid ventricular dysfunction, left ventricular filling before atrial contraction (reduced) E peak, A peak increased E / A ratio decreased. The pathogenesis of diabetic heart disease is very complex and still not fully elucidated. Difficult clinical diabetes heart disease pathological basis, so the diagnosis of this type of heart disease is often more difficult. Therefore, this study, CT measurement of type 2 diabetes mellitus patients with intra-abdominal fat area was observed intra-abdominal obesity with type 2 diabetic patients with cardiac structure and functional changes explore the intra-abdominal obesity and RBP4 APN expression level of the relationship and the pathogenesis of diabetic heart disease may to provide the basis for heart disease prevention, prediction and treatment of diabetes. Methods: inclusion and exclusion criteria to select a total of 198 patients with type 2 diabetes hospital from September 2009 to September 2010 at the Third Hospital of Hebei Medical University, Department of Endocrinology. The the patient supine breath-hold state to the multi-spiral CT umbilical level plane for a single-layer cross-sectional scanning, measurement of intra-abdominal fat area (VA), the subcutaneous fat area (SA), to calculate the intra-abdominal fat area / subcutaneous fat area ratio (VA / SA) . Intra-abdominal obesity (VA ≤ 100cm 2 ) as the control group (A group), 34 patients (18 male and 16 females), mean age (55.76 ± 10.62) years old. Intra-abdominal obesity of 164 patients with type 2 diabetes, according to the intra-abdominal fat area divided into two groups (group B and group C), B 82 patients (38 males and 44 females), mean age (median 56.03 ± 8.35 years); C 82 patients (45 men, 37 women), mean age (57.26 ± 10.37) years old. Clinical data capture subjects: Record of basic information, including gender, age (AGE), marital, ethnic, occupational, duration, family history, personal history (diet, living habits, smoking, alcohol consumption, etc.), past medical history ( coronary heart disease, hypertension and other disease history), the measurement of waist circumference, hip circumference, height, weight, blood pressure, calculate the waist-to-hip ratio, body mass index (BMI). Early morning the mining fasting blood fasting blood glucose (FBG), total cholesterol (TC), the triester triglyceride (TG), high density lipoprotein - cholesterol (HDL-C), low-density lipoprotein - cholesterol (LDL-C), fasting insulin (FINS), fasting C-peptide. With the law of the homeostasis model assessment insulin resistance index (HOMA-IR) formula: HOMA-IR = FBG × Fins/22.5. Glycated hemoglobin analyzer determination of glycosylated hemoglobin (HbA 1 c), urinary A / Cr values. Take the upper venous blood after centrifugation serum stored at -80 ℃ cryopreservation spare, unified RBP4, APN serum concentrations were measured by ELISA. Cardiac structure and function parameters of the three groups of subjects were measured with echocardiography, two-dimensional and M-mode ultrasound measurement of left ventricular end-diastolic diameters, left ventricular end-diastolic diameter (LV), interventricular septal thickness (IVS) and left ventricular after wall thickness (LVPW,), calculation of ejection fraction (EF), left ventricular fractional shortening (FS). Doppler ultrasound recording mitral flow, measured early left ventricular filling wave (E peak) maximum flow rate (Peake) (cm / s), late diastolic left atrial contraction wave (A peak) maximum flow rate (cm (PeakA) / s), Peake / A ratio. Devereux method, LVM = 1.04 × [(IVS LV LVPW) 3 -LV 3 ] -13.6, calculated left ventricular mass (LVM). All Statistics with SPSS 13.0 software completed, p lt; 0.05 (two-tailed) for the difference was statistically significant. Groups of measurement data normality test, normal distribution variables x ± s, non-normally distributed variables are expressed as median (interquartile range), count data n (%). Normally distributed variables were logarithmically transformed normally distributed variables between the two groups with one-way ANOVA analysis (one-way ANOVA), pairwise comparisons using the SNK test (homogeneity of variance) or Dunnett's T3 (unequal variances ). Count data groups were compared using the chi-square test. Among the factors using simple correlation and regression analysis, Pearson correlation coefficient describing the intensity. Multiple linear stepwise regression analysis testing the exclusion of other factors that affect intra-abdominal fat area, RBP4, APN and left ventricular mass relationship, logistic regression analysis of forecast intra-abdominal fat increase in the area of ??left ventricular diastolic dysfunction risk of multi- linear regression and logistic regression analysis of inclusion and exclusion criteria for p LT; 0.05 and p GT; 0.10. Results: Comparison between the three groups, their age, duration of disease, smoking, diastolic blood pressure, hip, glycosylated hemoglobin was no significant difference. Three groups WC, WHR, SBP, VA, SA, TC, HDL-C, LDL-C, FPG, RBP4, APN difference was statistically significant (p lt; 0.05 or p LT; 0.01) Where A group WC, WHR, SBP, VA, SA, TC, TG, LDL-C, FPG, RBP4 than B, C two groups were low, A group of HDL-C the APN level than B, C two groups. Compared with group A, B, C group BMI, V / S, urinary A / Cr was significantly higher (p lt; 0.05 or p LT; 0.01), but the B, C group showed no significant difference (p gt; 0.05). Compared with group B, C group Fins increased (p lt; 0.05). 2 Compared with group A, group B and group C LV, IVS, LVPW, LVM, PeakA Peake / A lt; 1 (%) increase in EF (%), Peake reduced (p lt; 0.05 or p lt ; 0.01). The C group LV, LVPW, LVM, Peake / A lt; 1 (%) elevated than in group B (p lt; 0.05 or p LT; 0.01), IVS, EF (%) PeakA for in B, C two groups between the difference was not statistically significant (p gt; 0.05). 3 pairs of APN and RBP4 expression level of conduct simple linear correlation analysis, showed that APN expression levels with the presence of WC, WHR, VA, SA, V / S, TG, LDL-C significantly with negative correlation (r value, respectively, for - 0.49, -0.35, -0.56, -0.40, -0.47, -0.53, -0.32), the APN expression levels with WC, VA, TG moderate intensity. WC, VA, SA, V / S, and TG exist in varying degrees and RBP4 linear correlation (P lt; 0.01), wherein VA strongest intensity (r = 0.36). BMI, TC, HDL-C and APN, RBP4 there is no linear relationship. 4 course of the disease, WC, WHR, VA, SA, V / S, TG, HDL-C, FPG, ln (HOMA-IR), APN, RBP4 with LVM has a certain degree of correlation (r = 0.35,0.26, 0.13,0.39,0.22,0.23,0.12 -0.24,0.28,0.45, -0.30,0.21), with statistical significance (P lt; 0.05) Control of confounding factors, the partial correlation analysis showed that WC, WHR, VA, V / S, ln (HOMA-IR), APN, RBP4 and other factors with LVM is still relevant. Strict control of confounding factors and interaction, stepwise multiple linear regression analysis showed that ln (HOMA-IR), APN, VA is independently associated with increased LVM, ln (HOMA-IR) on the dependent variable contribution followed by intra-abdominal fat area. Logistic regression analysis showed that of dyslipidemia (beta = 1.422, P = 0.041), intra-abdominal obesity (β = 0.847, P = 0.034), APN (β = -0.901, P = 0.006) into the regression equation, the equation has statistics significance (x = 20.531, P = 0.000). Dyslipidemia compared with normal blood lipids, left ventricular diastolic dysfunction (Peake / A lt; 1), occur than 1.422, left ventricular diastolic function in patients with intra-abdominal obesity, abnormal significant increase in the probability of occurrence. Conclusion: abdominal obesity by affecting glucose and lipid metabolism, insulin resistance, resulting in changes in cardiac structure and function, left ventricular diastolic function and myocardial hypertrophy changes in left ventricular systolic function abnormalities occur. 2 APN can increase insulin sensitivity, improve insulin resistance, regulation of lipid metabolism, against the increase in left ventricular mass, has a protective effect on left ventricular diastolic function. 3 of intra-abdominal fat accumulation enables RBP4 expression levels. Lower RBP4 levels can improve insulin resistance, increased insulin sensitivity. 4 CT measured abdominal fat area has a non-invasive, high accuracy, good repeatability, can be used as a method of assessment of abdominal obesity than BMI and WC.
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