老年2型糖尿病患者室性期前收缩特点研究

Features of Ventricular Premature Beats in Elderly Type 2 Diabetic Patients

目的探讨老年2型糖尿病(T2DM)患者室性期前收缩特点,为临床监测和治疗提供依据。方法选取2014年3月—2015年9月于郑州大学第二附属医院常规心电图检查发现室性期前收缩的T2DM患者138例为病例组,另选取同期在本院常规心电图检查发现室性期前收缩的体检者102例为对照组。受试者采用同步十二导联动态心电图仪进行24 h监测,记录室性期前收缩发生次数、部位,分析是否出现震荡起始(TO)、震荡斜率(TS)、连续心率减速力(DRs)异常。结果病例组24 h室性期前收缩>100次为109例(79.0%),对照组为68例(66.7%)。病例组24 h室性期前收缩>100次比例高于对照组(χ~2=4.597,P<0.05)。病例组0:00~5:59、18:00~23:59室性期前收缩发生次数高于对照组,6:00~11:59室性期前收缩发生次数低于对照组(P<0.05)。病例组0:00~5:59室性期前收缩发生次数均高于其他时间段(P<0.05)。病例组起源于左心室心尖部的室性期前收缩比例高于对照组,起源于右心室流出道的室性期前收缩比例低于对照组(P<0.05)。病例组TO、TS及DRs异常比例均高于对照组(P<0.05)。结论老年T2DM患者室性期前收缩更加频繁,尤其在凌晨显著,以起源于左心室心尖部为主,窦性心率震荡(HRT)及DRs异常率增高。

Objective To analyze the features of ventricular premature beats（VPBs） in elderly type 2 diabetic mellitus（T2DM） patients so as to provide a basis for clinical monitoring and treatment.Methods Of the people underwent routine electrocardiogram（EGG） in the Second Affiliated Hospital of Zhengzhou University from March 2014 to September 2015,we selected 138 elderly T2 DM patients and 102 physical examinees who were found with VPBs as the case group and control group,respectively.Both groups were monitored by 12-lead synchronous dynamic EGG for 24 hours.The frequency and original sites of VPBs occurred in both groups were recorded and analyzed to find whether the subjects had abnormal turbulence onset（TO）,turbulence slope（TS） and heart rate deceleration runs（DRs）.Results The ratio of subjects had more than 100 VPBs within 24 h was higher in the case group than in the control group（79.0%（109/138） vs.66.7%（68/102）,P〈0.05）.Compared with the control group,the case group had more VPBs occurring within 0：00-5：59 and 18：00-23：59,while less VPBs occurring within 6：00-11：59（P〈0.05）,higher ratio of VPBs originating from left ventricular apex and lower ratio of VPBs originating from right ventricular outflow tract（P〈0.05）,and higher incidences of abnormal TO,TS and DRs（P〈0.05）.The case group had more VPBs occurring within 0：00-5：59 than those occurring within 6：00-11：59,12：00-17：59,and 18：00-23：59（P〈0.05）.Conclusion VPBs occur in elderly T2 DM patients more frequently especially in early morning,which mainly originate from the left ventricular apex,and have a higher rate of abnormal HRT and DRs.