糖尿病对微伏级T波电交替影响的临床分析

Influence of diabetes on prevalence of abnormal microvolt T-wave alternans

目的 T波电交替(TWA)是心肌梗死后、缺血性心肌病、心力衰竭等患者发生心脏性猝死(SCD)的独立预测因子。相关研究报道糖尿病患者发生SCD的风险增加,但缺乏数据表明糖尿病患者微伏级T波电交替(microvoltT-Wave Alternans,MTWA)异常比例增加,本试验主要探讨糖尿病是否使MTWA异常的比例增高。方法选择自2000年1月至2011年5月兰州大学第一医院内科198例行平板运动试验的患者,分为A组:对照组,B组:糖尿病组,C组:冠心病组,D组:糖尿病合并冠心病组。用Logistic回归法对纳入患者MTWA与疾病相关性进行分析,并进一步分析糖尿病患者MTWA异常比例增高与血糖控制水平及病史的相关性。结果 Logistic回归显示异常MTWA与冠心病相关(p<0.001,OR=4.91,95%CI:2.52-9.55),与糖尿病相关(p=0.008,OR=2.39,95%CI:1.26-4.53)。对糖尿病患者进行Logistic回归显示MTWA异常仅与糖化血红蛋白相关(p=0.02,OR=6.00,95%CI:1.37-26.24),与糖尿病病史长短无关。结论 2型糖尿病患者中异常MTWA常见,异常比例为23.40%,MTWA异常比例增加与血糖控制水平具有相关性。

Objective To explore the relationship between microvoh T-wave ahernans （MTWA） and structural heart disease and the risk for sudden cardiac death. The presence of diabetes （DM） is associated with an increased risk of sudden death, so we tend to study the impact of DM on MTWA prevalence. Methods We performed a retrospective analysis in 198 patients referred for routine exercise testing. All patients were divided into 4 groups： group A [no DM or coronary heart disease（CHD）, group B（DM only）, group C（CHD only）, group D （DM and CHD）]. Patients performed an exercise test with assessment of MTWA by the modified moving average method. Results Logistic regression analysis in all patients showed that abnormal TWA was related to CHD （p〈0.001,OR=4.91,95%CI：2.52-9.55） and DM p=0.008, OR=2.39, 95%CI：1.26-4.53）. Conclusion Abnormal MTWA is a very common condition, about 23.40% among people with DM without CHD. The prevalence of abnormal MTWA was related to HbAlc, not related to duration of the DM.