糖尿病患者心率减速力和心率变异性等指标的检测分析

The analysis of heart rate deceleration capacity and variability in the diabetes

目的探讨心率减速力（DC）、连续心率减速力（DRs）和心率变异性（HRV）等指标的检测，对评估2型糖尿病患者的自主神经功能受损的作用。方法选择于我科检查的2型糖尿病患者100例，根据临床诊断，分为单纯糖尿病组和糖尿病肾病组各50例，选择同期健康体检者50例作为对照组。所有受检者进行24h动态心电图检查，检测DC、DRs和HRV指标：包括时域指标RR总体标准差（SDNN）、24h每5minRR间期平均值的标准差（SDANN）、差值均方根值（RMSSD）、相邻RR间期差值〉50ms的百分数（pNN50），频域指标低频功率（LF）、高频功率（HF）、及两者比值（LF／HF），比较3组差异。结果糖尿病肾病组与对照组比较，DC、HRV有关指标差异均有统计学意义（P〈0．05）；单纯糖尿病组与对照组比较，DC、HRV指标中除LF／HF外，差异均有统计学意义（P〈0．05），糖尿病肾病组与单纯糖尿病组比较，DC、HRV指标中SDNN、SDANN、LF、LF／HF差异有统计学意义（P〈0．05），单纯糖尿病组与对照组比较，DR1、DR3～DR7差异有统计学意义（P〈0．05）。糖尿病肾病组与对照组比较，DR1～DR10差异有统计学意义（P〈0．05）；与单纯糖尿病组比较，DR1-DR10中除DR2外，差异均有统计学意义（P〈0．05）。结论DC、HRV等指标检测有效评估糖尿病患者自主神经功能受损情况，且自主神经功能病变与糖尿病肾病关系密切。

Objective To study the clinical value of heart rate deceleration capacity （DC）, heart rate deceleration runs （DRs） and heart rate variability （HRV） on automatic nervous function in the type 2 diabetes. Methods A totel of 150 participants including 100 type 2 diabetes and 50 normal subjects who came to our hospital were enrolled in the study. The diabetes were classified into two subgroups： the simple diabetes （50 cases） and the diabetic nephropathy （50 cases）. All subiects underwent 24-hour dynamic electrocardiogram, DC, DRs and HRV tests which included SDNN, SDANN, RMSSD, pNNS0, LF, HF, LF/HF. We compared the differences of these parameters among the three groups. Results When comparing the diabetic nephropathy group and the normal group, all indexes were significantly different （P〈0.05）. As to the comparison between simple diabetes group and the normal group, the HRV related parameters were significantly different except for LF/HF, as well as DC, DR1, DR3-DR7 （P〈0.05）, hut there were no difference of DR2, DRS-DR10 （P〉0.05）. Except for DR2, all DRs were significantly different between the diabetic nephropathy group and the simple diabetic group, as well as DC, SDNN, SDANN, LF, LF/HF （P〈0. 05）. Conclusion By examining DC, DRs and HRV, damage of the functional autonomic nervous may be effectively detected in the diabetes which was closely related to diabetic nephropathy.