2型糖尿病合并代谢综合征患者心脏变时功能与代谢当量的观察

Association between chronotropic incompetence and metabolic equivalents in type 2 diabetic mellituspatients complicated with metabolic syndrome

目的了解2型糖尿病合并代谢综合征（MS）患者心脏变时功能及最大代谢当量水平及其关系。方法对66例合并MS门诊2型糖尿病患者行症状限制性心电运动平板试验，观察心脏变时功能不全指标，包括运动最高心率与预测最大心率值之比（rHR）、心率储备率（HRR）、运动能力中的最大代谢当量（maxMETs），以54例不合并MS的2型糖尿病患者为对照。结果2型糖尿病合并MS患者rHR为0．77±0．04，HRR为0．62±0．05，maxMETs为8．8±1．1，均低于不合并MS者[rHR为0．81±0．06，HRR为0．70±0．07，maxMETs为9．7±1．2]，差异有统计学意义（t值分别为3．41、5．96和0．16，均P〈0．05）。所有受试者的maxMETs与rHR、HRR均有相关性（r值分别为0．81和0．78，均P〈0．05）。结论2型糖尿病合并MS患者的心脏变时功能不全指标及maxMETs水平比不合并MS者低；心脏变时功能不全与maxMETs呈正相关，可与代谢当量或自感劳累等级共同作为运动量监测指标。

Objective To investigate the association between chronotropic incompetence （CI）and motor ability in type 2 diabetic mellitus （ T2DM ） patients complicated with metabolic syndrome （ MS）. Methods One hundred and twenty patients with T2DM were enrolled in the study, including 66 cases with MS （MS group） and 54 without MS （non-MS group）. The electrocardiographic exercise test was performed, the CI indexes including ratio of heart rate （rHR）, heart rate reserve （HRR）were measured and the max metabolic equivalents （maxMETs） were calculated. Result The rHR （0. 77±0. 04 vs. 0. 81±0. 06, t = 3.41, P 〈 0. 05）, HRR（0. 62 ±0. 05 vs. 0. 70 ± 0. 07, t = 5.96, P 〈 0. 05） and maxMETs （8. 8±1.1 vs. 9. 7±1.2, t = 0. 16, P 〈 0.05 ） in patients of MS group all lower than those in non-MS group. The maxMETs were positively correlated with rHR （ r = 0. 81, P 〈 0.05 ） and HRR （ r = 0. 78, P 〈 0.05 ）. Conclusion The results indicate that CI as well as maxMETs and rating of perceived exertion can be used as monitoring index in type 2 diabetic patients complicated with metabolic syndrome.