2型糖尿病伴无痛性心肌缺血患者的动态心电图分析

Study on silent myocardial ischemia in patients with type 2 diabetes mellitus by dynamic electrocardiogram

目的研究2型糖尿病（T2DM）无痛性心肌缺血（SMI）患者的动态心电图特点。方法采用分层（分类）抽样法，随机抽取24h动态心电图检测的单纯2型糖尿病患者65例（Ⅰ组），2型糖尿病合并无痛性心肌缺血患者51例（Ⅱ组），健康对照者45例（Ⅲ组），对比分析三组发生心律失常情况及三组心率变异性（HRV）时域指标。结果Ⅰ和Ⅱ组房性心律失常发生率差异无统计学意义，但分别与Ⅲ组相比，房性心律失常发生率差异均具有统计学意义；三组间室性早搏发生率差异均具有统计学意义；Ⅱ组与Ⅰ、Ⅲ组相比，室性心动过速发生率差异有统计学意义；三组HRV时域指标SDNN、SDANNIndex、SDNNIndex各组间比较差异均有统计学意义；rMSSD、PNN50Ⅰ与Ⅲ组比较差异有统计学意义，Ⅰ组与Ⅲ组比较差异无统计学意义。结论T2DM伴SMI患者室性心律失常发生率明显增高，HRV显著降低，心脏迷走神经损伤明显；动态心电图包括SMI及HRV检测对T2DM患者具有特殊意义。

Objective To study the feature of dynamic electrocardiogram in type 2 diabetes mellitus （T2DM） patients with silent myocardial ischemia （SMI）. Methods To randomly draw 65 cases of patients with fracture T2DM （group Ⅰ ） and 51 cases of patients with T2DM and SMI （group Ⅱ ） and 45 cases of the healthy （group Ⅲ ） from the cases determined by 24 h dynamic electrocardiogram. The arrhythmia and heart rate variability （HRV） of each case in the three groups were analyzed. Results The distinction of atrial arrhythmia in group Ⅰ and Ⅱ was not significant, but was significant comparing with group Ⅲ. The distinction of ventrieular premature beat incidence was significant respectively in the three groups. Comparing with group Ⅰand Ⅲ, the incidence of ventricular tachycardia in group Ⅱ was significant higher. The distinction of SDNN, SDANN Index and SDNN Index in three groups were significant. The distinction of rMSSD and PNN50 in group Ⅱ and Ⅲ was significant, but was not significant in group Ⅰ and Ⅲ. Conclusion In T2DM patients with SMI, the incidence of ventricular arrhythmia was significant high, HRV was significant low, which may reflect the vagus nerve function was demaged more seriously. The determination of dynamic electrocardiogram including SMI and HRV are special significance in patients with T2DM.