柯尔克孜族与汉族2型糖尿病患者心率变异性研究

Heart rate variability in the Kirgiz and Han Chinese patients with type 2 diabetes mellitus

目的：通过观察柯尔克孜族与汉族2型糖尿病患者心率变异性（HRV），了解民族间差异，同时为预测2型糖尿病自主神经病变提供有效方法。方法选取行24 h 动态心电图检查的患者共146例，其中柯尔克孜族74例，男性42例，女性32例，确诊2型糖尿病患者有40例；汉族72例，男性29例，女性43例，确诊2型糖尿病患者为35例。所有患者均未服用降糖药物，检测糖化血红蛋白并进行心率变异性分析。结果柯尔克孜族与汉族患者相比一般情况如年龄、性别、受教育程度及吸烟等差异均无统计学意义。柯尔克孜族2型糖尿病患者与非糖尿病患者相比，24 h 连续正常 R-R 间期的标准差（SDNN）、5 min 测量的正常 R-R 间期标准差均数（SDNN5）、24 h 内相邻的两个正常 R-R 间期差值＞50 ms 的个数占总心率数的百分比（PNN50）、24 h 内每5分钟正常 R-R 间期平均值的标准差（SDANN）、正常窦性 R-R 间期总个数除以 R-R 间期直方图高度得出的三角指数（TRIA）差异有统计学意义（t ＝3．392，P ＝0．001；t ＝3.652，P ＝0．001；t ＝3．826，P ＝0．001；t ＝3．235，P ＝0．002；t ＝2．378，P ＝0．02）；汉族2型糖尿病患者与非糖尿病患者相比，SDNN、SDNN5、PNN50、TRIA、24 h 连续记录的正常 R-R 间期差值的均方平方根（RMSSD）差异均有统计学意义（t ＝3．498，P ＝0．001；t ＝3．414，P ＝0．001；t ＝2．105，P ＝0．039；t ＝2．102，P ＝0．039；t ＝3.413，P ＝0．001）。两民族间非糖尿病患者HRV 指标无明显差异，而两民族间2型糖尿病患者 TRIA 差异有统计学意义（t ＝2．887，P ＝0．005）。结论24 h 动态心电图可以分析 HRV，判断自主神经活动在2型糖尿病中所起作用，是一项运用前景广泛且有价值的检测手段，而且作为一项无创、简单易行的辅助检查对判断糖尿病患者病情、估计预后、指导治疗有一定作用。

Objective To investigate the relationship between heart rate variability and type 2 diabetes mellitus（T2DM）in Kirgiz and Han,to understand the differences between ethnic groups,at the same time to provide effective method for type 2 diabetic autonomic neuropathy.Methods 24 -h Holter recording was performed in 1 46 individuals.75 cases of T2DMconfirmed by glycolated hemoglobin（HbA1 c）were selected as observation group, Kirgiz 40 people,Han 35 people.While 71 subjects without T2DM were chosen as control group,Kirgiz 34 people, Han 37 people.The HRV indices,including standard deviation （SD）for the time between normal -to -normal＆nbsp;complexes in the entire 24 h electrocardiographic recording（SDNN）,the average of SD for the time between normal -to -normal intervals for each 5 min period（SDNN5）,the percentage of adjacent RR intervals 50 ms apart（PNN50）, normal RR intervals divided by RR intervals derived from the triangle index（TRIA）,SD of the average normal -to -normal intervals for each 5 min period （SDANN）and root -mean square of differences of successive RR intervals （RMSSD）were compared between these groups.Results There were no significant differences in age,gender, education level and smoking between Kirgiz and Han patients.The differences were statistically significant in SDNN, SDNN5,PNN50,SDANN,TRIA（t =3.392,P =0.001 ;t =3.652,P =0.001 ;t =3.826,P =0.001 ;t =3.235,P =0.002;t =2.378,P =0.02）between patients with or without T2DMin Kirgiz population.In contrast,the mean square root of SDNN,SDNN5,PNN50,TRIA,RMSSD（t =3.498,P =0.001 ;t =3.41 4,P =0.001 ;t =2.1 05,P =0.039;t =2.1 02,P =0.039;t =3.41 3,P =0.001 ）were statistically significant in Han population between T2DM patients and nondiabetic patients.There was no deference between Han and Kirgiz patients without T2DM in HRV,whereas the TRIA（t =2.887,P =0.005 ）had significant difference in T2DM patients between Han and Kirgiz population. Conclusion The HRV is significantly reduced in the T2DMpatients,especially the Kirgiz.The HRV analysis using 24h Holter is a noninvasive technology to detect the T2DM.