非胰岛素依赖型糖尿病患者心血管自主神经功能与心率变异性

Cardiovascular autonomic function and heart rate variability in patients with noninsulindependent diabetes mellitus (NIDDM)

目的探讨非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者心血管自主神经功能变化与心率变异性（ＨＲＶ）的关系。方法ＮＩＤＤＭ患者４１例，按照标准心血管自主神经功能试验的结果分成阳性组（ＤＡＮ＋）及阴性组（ＤＡＮ－）；６１例健康人为对照组，进行ＨＲＶ分析。结果ＮＩＤＤＭ患者心血管自主神经功能异常的发生率为５３．７％，其发生率与病程呈正相关。ＤＡＮ＋及ＤＡＮ－组ＨＲＶ多数指标均明显降低（Ｐ值＜０．０５～０．０００１）；ＨＲＶ直方图、散点图、三维立体图均有特征性改变，以ＤＡＮ＋组最为显著。ＤＡＮ－组ＬＦ／ＨＦ值明显增大。结论ＨＲＶ能较全面、立体、直观、定量地反映ＮＩＤＤＭ患者心血管交感神经及迷走神经各自的功能状态，且稳定性、重复性及敏感性较好。因此。

Objective To investigate the characteristics of cardiovascular autonomic function (CAF) and heart rate variability (HRV) in NIDDM patients.Methods 41 patients with NIDDM and 61 healthy controls were involved in the study. According to the results of standard test of CAF, the NIDDM patients were divided into two groups——DAN+ group (patients with diabetic autonomic neuropathy) and DAN- group (patients without diabetic autonomic neuropathy). HRV (included 24hour timedomain, 24hour frequencydomain, 5minute frequencydomain, and nonlinear analysis methods) were measured to assess the changes of CAF in NIDDM patients. Results The positive rate of diabetic autonomic neuropathy in NIDDM patients was 53.7%, which correlated with duration of diabetic history. Compared with the control group, the indices of HRV (SDNN, RMSSD, PNN50, SDNNindex, SDANN, LF, HF, TP, VAI, VLI) were markedly and significantly reduced in both DAN- and DAN+ groups (P<0.050.0001), especially in DAN+ group. In DAN- group, LF and HF were significantly decreased (P<0.05 ), meanwhile, LF/HF was markedly increased (P<0.05) than those in DAN+ group.Conclusion (1)The positive rate of diabetic autonomic neuropathy in NIDDM patients was high. (2) HRV could be as a good method to detect earlier changes of CAF in NIDDM patients. (3) At the early stage of diabetic autonomic neuropathy, the decreases of HRV indices mainly reflect parasympathetic neuropathy, and at the late stage, all indices reflecting parasympathetic and sympathetic functions decreased significantly. (4)As a stable, reliable and sensitive method, HRV could be obtained clearly, directly and quantitatively for the assessment of CAF, which may probably get more information than that only by the standard test of CAF in NIDDM patients.