2型糖尿病患者的自主神经病变的研究

Clinical Study on Diabetic Autonomic Neuropathy

目的 :研究糖尿病患者临床症状、心血管反射试验 (CRT)、心率变异分析 (HRV)变化 ,以探讨DAN的发展变化 ,为临床DAN的诊治提供依据 .方法 :(1) 5 0例 2型糖尿病患者根据有无自主神经病变症状分为无症状 (DANS-)组和有症状 (DANS+ )组 ,根据心血管反射试验结果分为心血管反射实验阴性(CRT-)组 (Ewing评分 <2 )、心血管反射实验阳性 (CRT+ )组 (总分 2分 ) ;(2 )糖尿病患者与 2 5例正常对照者进行HRV短程频域分析 .结果 :(1)有症状的糖尿病患者较无症状者病程相对较长 ,糖化血红蛋白(HbA1c)明显增高 (P <0 0 5 ) .(2 )糖尿病患者CRT+ 为 4 8% ,有症状组中明显高于无症状组 (P <0 0 5 ) .(3)无症状的糖尿病患者HRV频域分析各项指标 [LF (nor) 10、HF (nor) 10、LF (nor) .4、HF (nor)4 ]与对照组相比均明显降低 (P <0 0 5 ) ,无症状组与有症状组相比HRV值亦明显降低 (P <0 0 5 ) . (4)CRT-的糖尿病患者HRV频域分析中 ,LF (nor) 10、LF (nor) 4、HF (nor) 4、LF/HF (nor) 4与对照组相比 ,均出现明显变化 ,CRT+ 的糖尿病患者与对照组及CRT-组相比 ,LF (nor) 10、HF (nor) 10、LF(nor) 4、HF (nor) 4均显著下降 (P <0 0 1) .(5 )对影响HRV频域分析的性别、年龄、病程等自变量进行逐步多元回归分析的结果?

Objective: To evaluate autonomic nervous functions in type 2 diabetes mellitus patients through the study of symptoms of diabetic autonomic neuropathy (DAN), cardiovascular reflex tests (CRT) and heart rate variability (HRV). Methods: According to evaluation of symptoms of DAN, 50 cases with type 2 diabetes mellitus were divided into DANS- group (patients with symptoms of DAN) and the DAN+ group (patients without symptoms of DAN); according to the results of CRT, diabetic patients were divided into CRT- group (patients with scores of CRT<2) and CRT+ group (patients with scores of CRT≥2). HRV were analyzed in all the diabetic patients and 25 controls. Results: (1) The duration of diabetic history in DANS+ group was longer than in DANS- group. And the HbA1c level was higher in DANS+ group. (2) The completely positive rate of CRT in 50 diabetic patients was 48%. (3) Compared with control group, the indices of frequency-domain HRV[LF(nor)10, HF(nor)10, LF(nor)4, HF(nor)4 in both DANS- group and DANS+ group were markedly reduced, especially in DANS + group. (4) Compared with control group, the indices of frequency-domain HRV [HF(nor)10, LF(nor)4, HF(nor)4] were markedly reduced and LF/HF(nor)4 was higher in DANS- group. The indices of frequency-domain HRV [LF(nor)10, HF(nor)10, LF(nor)4, HF(nor)4] were lower significantly in DANS+ group than in DANS-group. (5) In diabetic patients indices of frequency-domain HRV correlated with the duration of diabetic history, the HbA1c level and the CRT results were not correlated with gender, age, free blood glucose, fructosamine and symptoms of DAN. Conclusions: (1) the indices of frequency-domain HRV are markedly reduced in type 2 diabetes mellitus patients without symptoms of DAN and the scores of CRT≥2. With the appearance of symptoms of DAN and the increase of CRT scores, they are more reduced. (2) DAN is a progressive process. With the longer of diabetic history and the higher level of HbA1c, the lower the indices of frequency-domain HRV.