自主神经功能对糖尿病患者24小时动态血压和心率的影响

The effect of autonomic neuropathy on 24-hour dynamic blood pressure and heart rate in diabetic patients

采用24小时动态心电图和血压同步监测75例糖尿病患者和35例正常对照组。结果显示：随SDNN（24小时内全部正常R－R间期的标准差）的降低，糖尿病患者的24小时平均血压和心率、白昼收缩压和心率、夜间血压和心率均明显递增，昼夜血压差和心率差递减；24小时血压波动曲线由类似双峰双谷逐渐变为失去正常节律，且夜间血压高于白昼的血压曲线；视网膜病变和肾病的发生率也随之增高。结论：糖尿病患者高血压的发生、发展和昼夜血压节律的异常与自主神经病变有关；严重的昼夜血压节律异常者常伴有较高的微血管病变发生率。

The 24-hour dynamic electrocardiography and blood pressure (BP) monitoring were performed in 75 diabetic patients and 35 normal controls. The results showed: With reduction of the standard deviation of all normal R- R intervals in the whole 24-h ECG recording (SDNN), 24- hour mean BP and heart rate (HR), mean daytime systolic BP and HR, mean nighttime BP and HR were significantly increased,and the differences between daytime and nighttime BP and HR were significantly decreased. The circadian rhythms of 24 hour BP curves of double peaks and double valleys in the normals were lost gradually and the nighttime BP curves were higher than those of the daytime in the diabetic patients. The prevafence of retinopathy and nephropathy were also gradually elevated. Conclusion =The development of hypertension and the abnormality of circadian BP variation in diabetic patients are related to autonomic neuropathy. Serious abnormality of circadian BP variation is often accompanied by higher prevalence of diabetic microvascular complications.