2型糖尿病患者冠状动脉狭窄程度与心率变异性的关系研究

Association between severity of coronary stenosis and heart rate variability in patients with type 2 diabetes

目的 探讨2型糖尿病患者冠状动脉狭窄程度与心率变异性（HRV）下降的关系.方法 按性别分层随机选取2型糖尿病合并重度冠状动脉狭窄患者（冠脉动脉造影提示单支或多支血管狭窄≥75％）（A组）、2型糖尿病合并中度冠状动脉狭窄患者（冠状动脉造影提示≥50％狭窄）（B组）和2型糖尿病无或合并轻度冠状动脉粥样硬化患者（CTA提示冠状动脉无或轻度狭窄,运动平板阴性,C组）患者共90例,每组30例.回顾3组患者冠状动脉造影或冠状动脉CTA扫描前6个月内的24h动态心电图检查结果,比较、分析3组的HRV时域指标（SDNN、SDANN、rMSSD及pNN50）及频域指标（VLF、LF、HF及LF/HF）.结果 A组、B组和C组的SDNN值、SDANN值分别为（105.57±28.20）、（126.24±26.11）、（144.91±25.52）ms,（89.77±25.81）、（102.09±30.32）、（126.13±27.48）ms,3组间的差异均有统计学意义（均P＜0.05）.线性趋势x2检验显示SDNN和SDANN值下降程度与冠状动脉狭窄程度呈线性相关（P＜0.01）.此外,rMSSD和pNN50在B组与C组间的差异有统计学意义（P＜0.05）,LF/HF在A组与C组间的差异有统计学意义（P＜0.05）.结论 2型糖尿病患者冠状动脉狭窄程度越重,HRV指标的SDNN、SDANN值越小,在中重度冠状动脉狭窄患者中rMSSD、pNN50同时降低,反映HRV时域指标将来可能成为预测冠状动脉狭窄程度的指标.

Objective To evaluate the relationship between the severity of coronary stenosis and heart rate variability （HRV）. Methods Thirty patients with severe coronary stenosis （≥75%）（group A）, 30 patients with moderate coronary stenosis （≥50%）（group B） and 30 patients with mild or no coronary stenosis（group C） were recruited in the study. The dynamic electro- cardiogram results, including time-domain HRV parameters SDNN, SDANN, rMSSD and pNN50, and frequency-domain HRV parameters VLF, LF, HF and LF/HF 6 months before coronary angiogram or CT scan were retrospectively analyzed. Results SDNN had a linear trend of decline in group A, group B and group C [（105.57± 28.20）, （126.24 ± 26.11）, （144.91 ±25.52）ms, P〈0.05], SDANN had a linear trend of decline in groups A, B and C [（89.77 ±25.81）,（102.09 ± 30.32）, （126.13 ± 27.48）ms, P〈 0.05]. The severity of coronary stenosis showed a trend of increase with SDNN and SDANN declining （P〈0.01）. The difference of rMSSD and pNN50 between group B and group C was statistically significant （P〈0.05）. The difference of LF/HF between group A and group C was statistically significant （P〈0.05）. Conclusion The severity of coronary stenosis is negatively corre- lated with SDNN and SDANN values in patients with type 2 diabetes; rMSSD and pNN50 values are decreased in patients with severe and moderate coronary stenosis, which indicating that time parameters of HRV may be used as the predictors of coro- nary stenosis.