动态心电图在2型糖尿病患者心脏自主神经功能评价中的应用价值研究

Application value of the cardiac autonomic function evaluation monitored by Holter in type 2 diabetes

目的探讨动态心电图在2型糖尿病患者心脏自主神经功能评价中的临床应用价值。方法选择我院2013-05—2014-05间收治的2型糖尿病患者120例为研究对象,并根据传统心血管自主神经功能测定结果分为A组(自主神经损伤)62例和B组(自主神经正常)58例,采用动态心电图对心脏变时功能不全、心率变异(HRV)及心率震荡(HRT)等指标进行检查分析,评定该检查方法的临床应用价值。结果 (1)A组与B组的平均心率无明显差异(P>0.05)。但A组的最快心率明显低于B组,最慢心率明显高于B组,2组差值以A组更低,差异具有统计学意义(P<0.05);(2)A组的SDNN、SDANN、rMMSD等HRV指标均显著低于B组,而HRT指标中的震荡斜率(TS)也显著低于B组,差异具有统计学意义(P<0.05)。但2组间的震荡初始(TO)值则无明显差异(P>0.05)。结论采用动态心电图记录心脏变时性功能不全指标以及心率变异(HRV)、心率震荡(HRT)指标可准确评价2型糖尿病患者的心脏自主神经功能,具有一定的诊断价值,值得临床推广使用。

Objective To investigate the clinical value of holter monitoring the cardiac autonomic function evaluation in type 2 diabetic patients. Methods 120 cases with type 2 diabetes in our hospital from May 2013 to May 2014 were selected as the research subjects and were divided into group A （autonomic nerve damage） with 62 cases and group B（normal autonomic nervous system） with 58 cases based on the detected outcomes of traditional cardiovascular autonomic function. We inspected and analyzed the ability of heart rate response ,heart rate variability （HRV） and heart rate turbulence （HRT ） by Holter ,and the clinical value of the Holter was assessed. Results ① The average heart rate showed no significant difference between group A and group B（P〉0.05）. While the maximum rate in group A was significantly lower than that in group B ,the minimum heart rate was significantly higher than that in group B ,with a significant difference （P〈0.05）;②Both the HRV indexes such as SDNN ,SDANN ,rMMSD and the turbulence slope （TS） of HRT indicator of group A were significantly lower than those of group B （P〈0.05）. The initial shock （TO） between the two groups had no significant difference （P〉0.05）.Conclusion The Holter used to record the dysfunction of heart rate response ,HRV and HRT can accurately evaluate the cardiac autonomic function in patients with type 2 diabetes ,which should be applied as a consequence of its diagnostic value.