老年2型糖尿病合并冠心病患者的心率变异性研究

Heart rate variability in the elderly patients with type 2 diabetes combined with coronary heart disease

目的检测老年2型糖尿病合并冠心病患者的心率变异性并分析其临床意义。方法选取我院收治的84例老年2型糖尿病合并冠心病患者为研究对象(观察组),选取同期60例健康老年志愿者为对照组,所有观察对象均进行24 h动态心电图检查,比较两组观察对象的心率变异性指标。结果两组观察对象平均心率比较差异无统计学意义(P>0.05)。观察组患者的R-R间期总体标准差、平均值标准差、标准差的平均值、平方根和总R-R间期数的百分比分别为(86.1±2.8)ms、(86.1±4.1)ms、(19.2±2.9)ms、(13.9±3.1)ms和(3.6±1.8)%,均低于对照组的(127.6±3.1)ms、(128.1±4.7)ms、(59.2±2.6)ms、(35.4±3.5)ms和(13.8±2.2)%,两者比较差异均有统计学意义(P<0.05)。观察组患者睡眠状态时的时域性相关指标平均值标准差、平方根和总R-R间期数的百分比分别为(86.3±4.1)ms、(14.1±2.4)ms和(3.7±1.2)%,与清醒状态时的(85.1±4.7)ms、(13.8±2.7)ms和(3.6±1.1)%比较,差异均无统计学意义(P>0.05)。对照组观察对象睡眠状态时的时域相关性指标平均值标准差、平方根和总R-R间期数的百分比分别为(131.3±4.2)ms、(39.5±2.6)ms、(16.5±1.9)%,均高于清醒状态时的(95.2±3.9)ms、(27.1±2.2)ms和(10.6±1.8)%,其差异均有统计学意义(P<0.05)。结论心率变异性可反映心脏交感神经和迷走神经功能状况,可用于2型糖尿病合并冠心病患者自主神经系统损伤的评估。

Objective To detect the heart rate variability in the elderly patients with type 2 diabetes com- bined with coronary heart disease, and to analyze the clinical significance. Methods Eighty-four elderly patients with type 2 diabetes combined with coronary heart disease were enrolled into observation group, and 60 elderly healthy vol- unteers were enrolled into the control group. Then the heart rate variability index of the two groups were compared. Results The comparison showed that the difference of the average heart rate between the observation group and con- trol group was not statistically significant. The SDNN, SDANN, SDNN index, RMSSD and PNN50% in the observa- tion group were （86.1±2.8） ms, （86.1±4.1） ms, （19.2±2.9） ms, （13.9±3.1） ms and （3.6±2.2）%, which were significantly lower than those of （127.6±3.1） ms, （128.1±4.7） ms, （59.2±2.6） ms, （35.4±3.5） ms and （13.8±2.2）% in the control group （all P〈0.05）. The SDANN, SDNN index, and PNN50% of the observation group at sleep state were （86.3±4.1） ms, （14.1±2.4） ms and （3.7±1.2）%, which showed no statistically significant difference with those of（85.1±4,7） ms, （13.8± 2.7） ms and （3.6± 1.1）% at waking state. The SDANN, SDNN index, and PNN50% of the control group at sleep state were （131.3±4.2） ms, （39.5±2.6） ms and （16.5±1.9）%, which were significantly higher than those of （95.2±3.9） ms, （27.1±2.2） ms and （10.6±1.8）% at waking state were （all P〈0.05）. Conclusion The heart rate variability can reflect the status of cardiac sympathetic nerve and vagus nerve function, and can accurately assess the autonomic nervous sys- tem injury of type 2 diabetes combined with coronary heart disease.