2型糖尿病合并冠心病患者心率变异、室性心律失常与QT离散度的关系

Relationship of heart rate variability,ventricular arrhythmia and QT dispersion in patients with type Ⅱ diabetes mellitus complicated with cornary heart disease

[目的]探讨2型糖尿病（T2DM）合并冠心病（CHD）的心率变异（HRV）、室性心律失常（VA）与QT离散度（QTd）的关系。[方法]选择2008年1月-2009年10月大连医科大学附属第二医院北院62例健康对照者（A组）,78例2型糖尿病患者（B组）、71例2型糖尿病合并冠心病患者（C组）,分别做24 h动态心电图,分析其HRV时域分析和频域分析参数及其VA的发生情况;做常规12导联同步心电图,测定QT间期及QTd。[结果]（1）C组的HRV各项参数均低于A组和B组（P〈0.01）,并有随着VA程度的加重而降低的趋势;时域分析中的SDNN、SDANN、SDANN-index、RMSSD、PNN50与VA程度呈弱负相关（P〈0.05）;QTd均大于A组和B组（P〈0.01,P〈0.05）。（2）B组和C组的VA、QTd与SDNN、SDANN、SDNNA-index、RMSSD、PNN50均存在着负相关（P〈0.05）。[结论]T2DM合并CHD者心脏自主神经损害较单纯T2DM者重,前者迷走神经受损较后者更重。对T2DM及T2DM合并CHD者常规24 h动态心电图检查,测量QTd是有益的,有利于筛选出高危患者。

[Objective]To investigate the relationship of heart rate variability（HRV）,ventricular arrhythmia and QT dispersion（QTd） in patients with type Ⅱ diabetes mellitus（T2DM） complicated with coronary heart disease（CHD）.[Methods]Sixty-two normal healthy subjects were in group A as control,78 patients with T2DM were in group B and 71 patients with type Ⅱ diabetes mellitus（T2DM） complicated with CHD were in group C.Twenty-four hour domain and 24-hour frequency domain parameters of HRV and ventricular arrhythmia（VA） were recorded by holter ECG and analyzed with computer.A standard 12-lead synchronous electrocardiogram was used to measure QT interval and QTd.[Results]（1） It was showed that all parameters of HRV in group C were less than those in group A and B（P〈0.01）,and had a decreasing trend with the worsening of ventricular arrhythmia.There was a weak negative correlation between time domain indexes（SDNN,SDANN,SDANN-index,RMSSD or PNN50） and ventricular arrhythmia（P〈0.05）.The average of QTd in group C was more than that in group A and group B（P〈0.05 and P〈0.01）.（2） There were statistical negative correlations in VA,QTd and SDNN,SDANN,SDANN-index,RMSSD and PNN50between group B and group C（P〈0.05）.[Conclusion]The cardiovascular autonomic nerve damage in patients with T2DM complicated with CHD is more than that in T2DM.The pneumogastric nerves are more severely damaged in the former than in the latter.To check HRV,ventricular arrhythmia and measure QTd in patients with T2DM complicated with CHD are beneficial to find the high risky patients earlier.