非胰岛素依赖型糖尿病患者心血管自主神经功能与心率变异性

1、非胰岛素依赖型糖尿病患者心血管自主神经功能与心率变异性 2010-09-07 苗青吕卓人夏仲淘钱新叶刘淑媛 【摘要】目的探讨非胰岛素依赖型糖尿病（NIDDM）患者心血管自主神经功能变化与心率变异性（HRV）的关系。方法NIDDM患者41例，按照标准心血管自主神经功能试验的结果分成阳性组(DAN+)及阴性组(DAN-)；61例健康人为对照组，进行HRV分析。结果NIDDM患者心血管自主神经功能异常的发生率为53.7%，其发生率与病程呈正相关。DAN+及DAN-组HRV多数指标均明显降低(P值<0.050.0001)； HRV直方图、散点图、三维立体图均有特征性改变，以DAN+组最为显著。D

2、AN-组LF/HF值明显增大。结论HRV能较全面、立体、直观、定量地反映NIDDM患者心血管交感神经及迷走神经各自的功能状态，且稳定性、重复性及敏感性较好。因此，HRV分析是一种为临床早期发现NIDDM患者心血管自主神经功能异常的较好方法。 【关键词】糖尿病，非胰岛素依赖型糖尿病神经病变心率变异性 Cardiovascular autonomic function and heart rate variability in patients with non-insulin-dependent diabetes mellitus (NIDDM)Miao Qing*, Lü Zhuor

3、en, Xia Zhongtao, et al. * Department of Geriatrics, Shanxi Provincial People's Hospital , Xi'an 710068 【Abstract】ObjectiveTo investigate the characteristics of cardiovascular autonomic function (CAF) and heart rate variability (HRV) in NIDDM patients.Methods41 patients with NIDDM and 61 hea

4、lthy controls were involved in the study. According to the results of standard test of CAF, the NIDDM patients were divided into two groupsDAN+ group (patients with diabetic autonomic neuropathy) and DAN- group (patients without diabetic autonomic neuropathy). HRV (included 24-hour time-domain, 24-h

5、our frequency-domain, 5-minute frequency-domain, and non-linear analysis methods) were measured to assess the changes of CAF in NIDDM patients. ResultsThe positive rate of diabetic autonomic neuropathy in NIDDM patients was 53.7%, which correlated with duration of diabetic history. Compared with the

6、 control group, the indices of HRV (SDNN, RMSSD, PNN50, SDNNindex, SDANN, LF, HF, TP, VAI, VLI) were markedly and significantly reduced in both DAN- and DAN+ groups (P<0.05-0.0001), especially in DAN+ group. In DAN- group, LF and HF were significantly decreased (P<0.05 ), meanwhile, LF/HF was

7、markedly increased (P<0.05) than those in DAN+ group.Conclusion(1)The positive rate of diabetic autonomic neuropathy in NIDDM patients was high. (2) HRV could be as a good method to detect earlier changes of CAF in NIDDM patients. (3) At the early stage of diabetic autonomic neuropathy, the decre

8、ases of HRV indices mainly reflect parasympathetic neuropathy, and at the late stage, all indices reflecting parasympathetic and sympathetic fun ctions decreased significantly. (4)As a stable, reliable and sensitive method, HRV could be obtained clearly, directly and quantitatively for the assessmen

9、t of CAF, which may probably get more information than that only by the standard test of CAF in NIDDM patients. 【Key words】diabetes mellitus, non-insulin-dependentdiabetic neuropathiesheart rate variability 心血管自主神经病变是糖尿病最常见的并发症之一。在糖尿病伴严重心脏自主神经病变者中，无痛性心肌梗塞、恶性心律失常、心脏性猝死的发生率明显增加1。寻求早期检出糖尿病心血管自主神经病变较敏感、

10、可靠的方法，是近年来糖尿病研究的热点之一。本研究探讨了非胰岛素依赖型糖尿病(NIDDM)患者心血管自主神经功能改变的特点与心率变异性(HRV)的关系，以期为临床上提供早期发现NIDDM患者心血管自主神经功能异常的较好方法。 资料与方法 一、对象 1.对照组：正常健康人共61例，其中男35例，女26例，平均年龄52±9.75（28±68）岁。均符合无临床器质性疾病（如糖尿病、心脏病、甲亢、高血压、肾脏疾病等）、无精神疾病的入选标准。 2.糖尿病组：确诊的NIDDM患者62例，其中男38例，女24例，平均年龄54±10.60（3072）岁，平均病程4.88±

11、6.87年（1月20年）。所有患者均符合WHO诊断标准，均无高血压或心脏病史，常规心电图正常。检查前1周内未用影响神经及心血管系统的药物。所有的病人均用口服降糖药物治疗。 二、方法 1.试验前夜及当日禁饮咖啡、茶、酒，禁吸烟，并禁用任何影响血压、心率的药物。保证充足睡眠，避免剧烈运动, 试验前坐位安静休息30分钟。 2.标准心血管自主神经功能试验2，3：包括以下前3项心血管副交感神经试验及后2项交感神经试验：(1)Valsava动作反应指数：正常值为1.21，临界值1.101.20，阳性值小于1.10；(2)深呼吸时心率的变化（呼吸差）：正常值应大于15次/分，临界值为1015次/分，阳性值小

12、于10次/分；(3)由卧位到立位心率的即刻反应：正常值为1.04，临界值为1.001.03，阳性值小于1.00；(4)由卧位到立位血压的即刻反应（卧立压差）：正常值为收缩压下降小于1.33 kPa(10mmHg)，临界值1.334.00 kPa(1030 mmHg)，大于4.00 kPa(30mmHg)为阳性；(5)握力试验的血压反应：正常值为大于2.13 kPa(16mmHg)，临界值为1.332.13 kPa(1016mmHg)，小于1.33kPa(10mmHg)为阳性。 上述试验均正常或迷走神经功能试验仅1项异常者为阴性；上述试验2项或2项以上异常者为阳性。 3. HRV分析:本研究采用由欧洲心血管学会和北美起搏电生理学会共同组成的HRV专题委员会