2型糖尿病患者非糖尿病后代心率变异性与血清脂联素水平的相关性研究

Association of serum adiponectin concentration with heart rate variability in non diabetic offspring of type 2 diabetic patients

目的旨在探讨血清脂联素浓度降低是否与2型糖尿病（T2DM）患者非糖尿病后代心率变异性（heart rate variability，HRV）改变有关。方法31例（男16例，女15例）T2DM患者，所有子女（91例）排除已进行药物治疗的T2DM患者14例，其余空腹静脉取血测定血浆葡萄糖，排除≥7．0mmol／L者3例，排除5．6～7．0mmol／L之间者7例。选择其空腹血糖≤5．6mmol／L后代行口服葡萄糖耐量试验，均未达到T2DM诊断标准，分为正常葡萄糖耐量组（NGT，n=32），葡萄糖耐量异常组（IGT，n=35），对照组（n=32）为无糖尿病家族史的健康查体者。行24h动态心电图检查测定HRV，指标包括：全部正常窦性R—R间期值的标准差（SDNN）；全程按5min分成连续的时间段，先计算每5min正常R-R间期的平均值，再计算所有平均值的标准差（SDANN）；全部相邻R—R间期差的均方根（rMSSD）；总功率（TP）；低频功率（LF）；高频功率（HF）。ELISA法测定血清脂联素。结果T2DM非糖尿病后代血清脂联素水平与其体重指数（BMI）、空腹胰岛素负相关，与高密度脂蛋白胆固醇（HDL—C）、SDNN、SDANN、rMSSD、TP、LF、HF正相关。对照组、NGT组、IGT组之间血清脂联素逐渐降低、空腹胰岛素、SDNN、SDANN、rMSSD、TP、LF、HF逐渐升高。IGT组BMI、血清三酰甘油高于HDL-c，低于对照组和NGT组。结论自主神经平衡的改变与胰岛素抵抗和血清脂联素水平改变具有相关性。

Objective To study the association of serum adiponectin concentrations with heart rate variability （HRV） in non diabetic offspring of type 2 diabetes mellitus（T2DM） patients. Methods Thirty-one T2DM subjects had 91 offspring, of whom, 24 were excluded, the left 67 offsprings（FPG≤5.6 mmol/L）were divided into two groups according to the outcomes of oral glucose tolerance tests （OGTT） ： normal glucose tolerance （NGT） group（n=32） and impaired glucose tolerance （IGT） group （n =35）. Twenty- five healthy subjects were recruited as control （control group）. Serum adiponectin concentration was measured. HRV was determined from 24-h Holter recording. Results There were significant differences in SDNN, SDANN, rMSSD, TP, LF, HF, fasting insulin and adiponectin concentrations among the three groups, in BMI, TG, HDL-c between IGT group and the rest two groups respectively. Serum adiponectin concentrations in non diabetic offspring of type 2 diabetic patients were negatively related to BMI, fasting insulin concentration, and positively related to HDL-c, SDNN, SDANN, rMSSD, TP, LF, HF. Conclusions The autonomic nerve impairment is associated with insulin resistance and the altered serum adiponectin concentration.