高血压和非高血压2型糖尿病患者心率变异性、压力反射敏感性和血压变异性频谱分析鉴定心脏自主神经病变

Detecting diabetic cardiovascular autonomic neuropathy by power spectral analysis of heart rate variability (HRV), baroreflex sensitivity(BRS) and blood pressure variability(BPV) in hypertensive and normotensive diabetic patients

目的采用心率变异性(HRV)、压力反射敏感性(BRS)和血压变异性(BPV)频谱方法了解高血压和非高血压T2DM患者心血管自主神经病变的诊断价值。方法 119例T2DM患者和101例非糖尿病对照者分别分为高血压(HT)和非高血压(NHT)亚组,均进行HRV、BRS和BPV检测。结果 DM组中HT和NHT亚组的TV.rri、VLF.rri、LF.rri和HF.rri均显著低于对照组。DM-HT组的Total.brs和HF. brs明显下降,BPV无改变;DM-NHT组的TV.bp和VLF.bp显著增加。结论糖尿病患者(无论有无HT)HRV下降,反映基础状态下心血管自主神经功能张力异常可能不受血压影响;DM合并HT患者BRS降低,提示DM合并HT可使心血管反射调节能力减退;无高血压的DM患者BPV增大,提示DM患者血压调定和稳态早期受损。

Objective To investigate diabetic cardiovascular autonomic neuropathy through power spectral analysis of HRV, BRS, and BPV in hypertensive and normotensive diabetic patients. Methods 119 patients with type 2 diabetic mellitus and 114 normal controls from the community were enrolled and divided into hypertensive and normotensive subgroups separately according to blood pressure. Cardiac autonomic function was assessed by power spectral analysis of HRV, BRS, and BPV. Results In both hypertensive and normotensive diabetic groups TV. rri,VLF, rri,LF, rri and HF. rri were significantly lower （P〈0. 05）. In hypertensive diabetic group, Total brs and HF brs considerably decreased（P〈0. 05）. In normotensive diabetic group, TV-bp and VLF -bp significantly increased（P〈0. 05）. Conclusions Regardless of the level of blood pressure, HRV parameters are all decreased in diabetic groups. This reflects an impairment of cardiovascular autonomic nerve tone at baseline state in diabetic patients. In diabetic hypertensive patients, BRS is decreased, which shows that essential hypertension acts synergistically with diabetes to depress cardiac vagal and sympathetic reflex function. On the other hand, higher BPV in the normotensive diabetic patients shows the early changes in homeostasis of blood pressure.