老年2型糖尿病患者下肢周围动脉病变与心率变异率相关性分析

Correlation of lower extremities peripheral arterial disease and heart rate variability in elderly patients with type 2 diabetes mellitus

目的探讨老年2型糖尿病患者（≥60岁）下肢周围动脉病变（PAD）与心率变异率（HRV）的关系。方法选择2012年6月至2014年7月在首都医科大学附属北京朝阳医院西区内分泌科住院的128例老年2型糖尿病患者，根据有无PAD（ABI〈0．9定义为PAD）分为两组。测定体质量指数（BMI）、血压、血脂、周围神经病变、尿微量白蛋白（UAER）、双下肢踝肱指数（ABI）和动态心电图，由仪器自动分析计算出HRV各项时域及频域指标。对两组间各项指标进行统计学分析。结果共128例患者，其中90例无PAD、38例合并PAD。2型糖尿病合并PAD组年龄、糖尿病病程、糖化血红蛋白（HbAlc）、甘油三酯（TG）、UAER及高血压发生率均高于无PAD组（P〈0．05）。PAD组患者HRV指标下降，包括大部分时域指标SDNN、SDNN-index、SDANN及频域指标低频功率、高频功率。校正年龄、糖尿病病程、HbA1c、TG、UAER、高血压后，HRV指标与PAD程度呈负相关。结论老年2型糖尿病合并PAD者具有更低的HRV，表明心脏自主神经系统调节能力下降。

Objective To investigate the correlation of lower extremities peripheral arterial disease （PAD） and heart rate variability （HRV） in the elderly patients （over 60 years） with type 2 diabetes mellitus （T2DM）. Methods A total of 128 T2DM patients admitted to our hospital from June 2012 to July 2014 were included in this study. All subjects were divided into 2 groups according to having PAD or not [ankle brachial index （ABI） 〈 0.9 defined as PAD]. Their body mass index （BMI）, blood pressure, serum lipids, peripheral neuropathy, urinary albumin excretion rate （UAER）, ABI and HRV were measured and analyzed. Results In the 128 T2DM patients, there were 90 patients having no PDA and 38 having. Those with PAD had older age, longer diabetes duration, higher UAER, higher incidence of hypertension, and higher levels of HbAle and triglycerides （TG） than the patients without PAD （P 〈 0.05）. And they had lower HRV indices, including those in time domain, such as, the standard deviation of the R-R intervals （SDNN）, mean of the standard deviation of the R-R intervals calculated in 5-rain segments （SDNN-index） and the standard deviation of the averages of R-R intervals （SDANN）, and those infrequency domain, high-frequency activity and low-frequency activity, for example. After adjustment for age, diabetes duration, UAER, levels of HbAlc and TC, and incidence of hypertension, HRV indices were negatively correlated with the severity of PAD. Conclusion In the cohort of the elderly T2DM patients, those with PAD have lower HRV indices than those without, suggesting a dysfunction of cardiovascular autonomic regulation.