冠心病合并2型糖尿病患者窦性心率震荡的变化

Changes of heart rate turbulence in patients with coronary heart disease and T2DM

目的探讨冠心病合并2型糖尿病(T2DM)患者窦性心率震荡(HRT)的变化及临床意义。方法测定冠心病合并T2DM患者(A组,43例)、冠心病患者(B组,45例)和对照组(C组,42例)HRT的初始值(TO)和斜率(TS),分析其与3-12个月随访期心脏恶性事件(心绞痛、心肌梗死、恶性心律失常、心源性猝死)发生的关系。结果 A、B组的TO值明显高于C组[(0.82±0.13)%、(0.69±0.09)%vs.(-0.67±0.07)%],但TS值明显低于C组[(1.92±1.79)ms/RR、(2.82±1.55)ms/RR vs.(6.81±2.61)ms/RR](P<0.05)。A组发生不良事件12例,B组10例;与无不良事件发生者比较,发生不良事件患者的TO明显升高,TS明显降低(P<0.05)。结论冠心病合并T2DM与冠心病患者的HRT异常,发生心脏不良事件的患者HRT减弱更显著。HRT分析可作为冠心病合并T2DM患者发生心脏事件的预测因素。

Objective To investigate the changes and significance of heart rate turbulence （HRT） in patients with coronary heart disease（CHD） and type 2 diabetes mellitus（T2DM）. Methods The onset（TO） and HRT slope（TS） of HRT were detected in three groups of A（42 CHD patients with T2DM）,B（45 CHD patients without T2DM） and C（42 patients without CHD or T2DM）. The association of HRT with the occurrence of cardiovascular events （angina pectoris, myocardial infarction, malignant arrhythmias, sudden cardiac death） during 3-12 months follow up was analyzed. Results The TO values of groups A and B were higher than those of group C[（0. 82±0. 13） % and （0.69±0. 09） % vs. （-0. 67±-0. 07） %], but the TS values of groups A and B were lower than those of group C [（1. 92±1.79） ms/RR and （2.82±1.55） ms/RR vs. （6.81±2. 61） ms/RR]（P〈0. 05）. The adverse cardiac events occurred in 12 cases of group A and in 10 cases of group B, in whom TO increased and TS decreased significantly more than those without occurrence of adverse cardiac events （P〈0. 05）. Conclusion The HRT is abnormal in CHD patients with or without T2DM, in whom HRT is blunted more significantly in the patients with the occurrence of adverse cardiac events. HRT analysis may be taken as an factor for predicting the occurrence of adverse cardiac events in CHD patients with T2DM.