糖尿病心脏自主神经病变患者抑郁及焦虑状态分析

An analysis of the depression and anxiety state of cardiovascular autonomic neuropathy in diabetes patients

目的观察分析不同阶段糖尿病心脏自主神经病变(Diabetic cardiovascular autonomic neuropathy,DCAN)患者心理学状态。方法采用Holter分析系统进行心率变异性(HRV)分析,依据评价CAN的标准分别对非DCAN、DCAN临床前期以及DCAN阳性患者进行HAMA和SDS量表测评。结果 278例观察对象中筛查并分类出DCAN阳性组62例(22.30/%),DCAN临床前期组88例(31.65/%),DCAN阴性组128例(46.04/%);3组间年龄、诊断糖尿病时间及Hb A1c差异均有统计学意义(P<0.05),3组间HRV时域指标SDNN、SDANN、SDNNI,频域指标LF及Mean HR等比较其差异均有统计学意义(P<0.05)。观察对象中53.95%的住院糖尿病患者存在不同程度DCAN,DCAN临床前期组46.59%的患者伴有轻中度抑郁而56.82%则伴有焦虑状态,DCAN阳性组56.45%的患者伴有中重度抑郁而69.35%伴有焦虑状态,DCAN阳性组轻度、中重度抑郁状态频数及焦虑状态频数均显著高于其他2组(P<0.05)。结论伴有不同程度的抑郁和(或)焦虑状态是DCAN及其临床前期患者的主要心理病理学特征。

Objective To understand the mental states of diabetes at different stages of DCAN. Method Holter analysis system was used to analyze the heart rate variability（ HRV）. Based on the CAN evaluation standards,non DCAN,preclinical DCAN and positive DCAN patients were assessed with HAMA and SDS Scales. Findings Of the 278 subjects,62（ 22. 30 / %） were tested positive for DCAN,88（ 31. 65 / %） for preclinical DCAN and 128（ 46. 04 / %） negative for DCAN. Statistically significant differences were found among the three groups in age,length of history of the disease of diabetes and Hb A1c（ p 〈0. 05）. The differences in HRV parameters SDNN,SDANN,SDNNI,and the differences in LF and Mean HR among the groups were also statistically significant（ p 〈0. 05）. 53. 95% of hospitalized diabetic patients have different degree of DCAN. 46. 59% of the patients experienced mild-to-moderate depression and 56. 82% experienced anxiety status in the DCAN preclinical group. In the DCAN positive group,56. 45% of the patients had moderate or severe depression and 69. 35% had anxiety. Conclusion It is a common feature of DCAN and preclinical DCAN patients toexperience varying degrees of depression and anxiety.