不同糖耐量状态下老年男性高血压患者窦性心律震荡的临床意义

The clinical change in heart rate turbulence in elderly male hypertensive patients with different glucose tolerance

目的探讨胰岛素抵抗与老年男性原发性高血压患者窦性心律震荡的(HRT)关系。方法将70例老年原发性高血压患者根据葡萄糖耐量试验结果分为高血压糖耐量正常组(EH+NGT)30例,糖耐量异常组(EH+IGT)20例和2型糖尿病组(EH+T2DM)20例,再进行24小时12导联同步动态心电图检测,计算HRT的震荡初始(TO)和震荡斜率(TS),对TO、TS与24 h正常窦性心律RR间期的标准差(SDNN)及左室舒张末内径(LEVDD)进行相关性分析。结果 EH+T2DM组TO、胰岛素抵抗指数(HOMA-IR)明显高于EH+IGT组、EH组(P<0.05),TS明显低于对照组(P<0.05)。在高血压合并糖代谢异常组内,HOMA-IR与TO、TS、SDNN、LEVDD有相关性(r=0.487,P=0.010;r=-0.187,P=0.040;r=-0.608,P=0.010;r=-0.236,P=0.043)。结论在老年高血压人群,糖代谢紊乱影响窦性心律震荡,可能为胰岛素抵抗加重自主神经功能损害所致。

Objective To investigate the changes of heart rate turbulence（HRT） in patients suffering from essential hypertension with different glucose tolerance in man and to explore the correlation between HRT and insulin resistance. Methods Seventy cases of essential hypertension combined with different glucose tolerance were enrolled in this study. All patients were monitored with 12-lead 24 h hoter. Turbulence onset （TO） and turbulence slope （TS） were calculated. Results TO in essential hypertension group rose significantly （ P 〈 0.05 ） with the increasing of blood glucose and TS decreased inversely. TO and TS are relevant with the insulin resistance index（ HOMA-IR,P 〈0. 05）. Conclusion In elderly male hypertensive patients, glucose metabolism disorders may influence the HRT, the autonomic nervous function is damaged with the insulin resistance.