心电图运动平板试验评价2型糖尿病的运动安全性研究

Safety evaluation of ECG exercise test on type 2 diabetes mellitus

目的通过对既往病史中无临床大血管病变的2型糖尿病(T2DM)患者进行动脉粥样硬化程度分层,并结合运动负荷试验结果,筛选能提示T2DM患者运动风险的指标。方法通过超声测定右颈动脉内中膜厚度(IMT),将T2DM患者分为动脉粥样硬化组(IMT>1.3 mm或有斑块)44例和非动脉粥样硬化组(IMT≤1.3 mm)31例。行运动负荷试验,并根据结果将T2DM患者又分为运动负荷试验阳性组10例和阴性组65例,监测运动中心电指标变化。结果 (1)动脉粥样硬化组与非动脉粥样硬化组、运动负荷试验阳性组与阴性组比较,基线资料差异均无统计学意义(均为P>0.05),肝肾功能、空腹血糖、糖化血红蛋白、血脂水平差异也均无统计学意义(均为P>0.05)。(2)与动脉粥样硬化组比较,非动脉粥样硬化组运动中最高心率显著增加[(144.3±7.6)次/min比(140.1±8.3)次/min,P=0.025];与运动负荷试验阴性组比较,阳性组运动后3 min收缩压显著增高[(151.9±19.0)mmHg比(137.9±18.7)mmHg,P=0.031]。(3)运动负荷试验阳性与运动后3 min收缩压呈正相关(r=0.211,P=0.029),动脉粥样硬化与运动中最高心率呈负相关(r=-0.254,P=0.028)。运动结束后3 min收缩压升高是运动负荷试验阳性的独立危险因素(B=0.104,P=0.012),运动中最高舒张压增高及最高心率降低是动脉粥样硬化的独立危险因素(B=0.054,P=0.017;B=-0.119,P=0.017)。结论无临床大血管病变的T2DM患者运动负荷试验结束后3 min收缩压增高,对预测心肌缺血有临床意义。

Objective To screen the risk indicators of myocardial ischemia （MI） during the treadmill test in type 2 diabetic patients without clinical macroangiopathy. Methods To screen the risk indicators of myocardial ischemia （MI） during the treadmill test in type 2 diabetic patients without clinical macroangiopathy. Methods According to the ultrasonic results of the right carotid intima-media thickness （IMT） , 75 type 2 diabetic patients were divided into atherosclerosis group （ AS ： IMT 〉 1.3 mm or with plaques, 44 cases） and non-atherosclerosis group （NAS： IMT≤1. 3 mm, 31 cases）. All participants were involved in the Bruce＇s treadmill test, and ECG and blood pressure were monitored during and 3 minutes after the test. Fasting blood glucose, serum lipids and glycosylated hemoglobin were also measured. All data were also analyzed between positive group （with presence of MI） and negative group （without MI） according to their ECG results during the test. Results （ 1 ） There were no significant differences of age, gender, BMI, waist circumference, family history of ischemic heart disease, history of smoking and alcohol drinking between AS and NAS groups , and also between the positive and negative MI groups （ all P 〉 0. 05 ）. There were no significant differences of fasting blood glucose, serum lipids and glycosylated hemoglobin between AS and NAS group, and positive and negative MI groups （ all P 〉 0. 05 ） . （ 2 ） The maximum heart rate （HRmax） in NAS group was significantly higher than in AS group [ （ 144. 3 ± 7. 6 ） bpm vs. （ 140.1 ± 8.3 ） bpm, P = 0. 025 ] during the test. The systolic pressure （SBP） 3 minutes after the test was significantly higher in MI positive group than in negative group [ （151.9 ± 19. 0）mmHg vs. （137. 9 ± 18.7）mmHg, P = 0. 031 ]. （ 3 ） The MI positive result of treadmill test correlated with the higher SBP 3 minutes after test （ r = 0. 211, P = 0. 029 ）, and AS negatively correlated with HRmax during the test （ r = - 0. 254, P = 0. 028 ） . According to the regression analysis, higher SBP 3 minutes after test was an independent risk factor of the positive MI during the treadmill test （ B = 0. 104, P = 0. 012 ）, and the higher maximum diastolic pressure and lower HRmax were the independent risk factors of atherosclerosis （ B = 0. 054, P = 0. 017 ; B = - 0.119, P = 0. 017 ） , respectively. Conclusions Here is accommodation of disturbance of blood pressure and heart rate in type 2 diabetes with AS, and the potential MI risk existed during the exercise in diabetic patients, although without clinical macroangiopathy. The higher SBP 3 minutes after test could be the indicator of MI in type 2 diabetes.