不同年龄段2型糖尿病伴心血管自主神经病变患者心率减速力和Tp-e/QT比值的变化特点研究

Characteristics of deceleration capacity and Tp-e/QT value in different age groups of patients with diabetic autonomic neuropathy

目的观察不同年龄段糖尿病伴心血管自主神经病变(CAN)患者心率减速力(DC)和Tpe/QT比值的变化特点并分析影响因素。方法选取糖尿病伴心血管自主神经病变患者(DM+CAN组)287例、糖耐量正常的CAN患者(CAN组)130例及健康体检者(NC组)150名,再根据年龄范围将DM+CAN组行三分位法分组:低分位(35.0~47.2岁)亚组91例、中分位(47.3~59.6岁)亚组116例及高分位(59.7~72.0岁)亚组80例。各组均接受标准12导联心电图和24 h动态心电图检测,计算DC和Tp-e/QT比值并分析两者的影响因素。结果DM+CAN组WC、SBP、BMI、FPG、HbA_1c、FIns及HOMA-IR高于CAN组和NC组(P<0.05或P<0.01)。DM+CAN组、CAN组、NC组,DC依次升高,Tp-e/QT依次降低(P<0.05或P<0.01);高分位亚组和中分位亚组糖尿病病程、WC、FPG、FIns、HbA_1c、HOMA-IR、高血压和冠心病患者比例均高于低分位亚组,高分位亚组糖尿病病程和FIns高于中分位亚组(P<0.05或P<0.01);高分位亚组平均心率(RHR)和静息心率(AHR)均低于低分位亚组(P<0.05),而中分位和低分位亚组比较,差异无统计学意义(P>0.05)。从高分位亚组到低分位亚组,DC逐渐升高[(2.90±0.47)vs(4.22±0.41)vs(4.97±0.35)ms],Tp-e/QT逐渐降低[(0.23±0.05)vs(0.18±0.03)vs(0.12±0.02)](P<0.05或P<0.01);多元逐步回归分析显示,年龄、糖尿病病程、WC、FPG、HbA_1c、合并高血压、合并冠心病是DC和Tp-e/QT比值共同的危险因素(P<0.05)。结论随年龄升高,糖尿病伴心血管自主神经病变患者DC水平降低,Tp-e/QT比值增高。对于年龄高、糖尿病病程长,WC、FPG、HbA_1c水平升高及合并高血压和冠心病的患者可考虑常规进行动态心电图检测,有效预防心血管事件的发生。

Objective To investigate characteristics of deceleration capacity （DC） and Tp-e/QT value in different age groups of patients with diabetic autonomic neuropathy, and to analyze their influencing factors. Methods A total of 487 subjects were enrolled in this study, and divided into three groups., patients with diabetic autonomic neuropathy （DM＋ CAN group, n = 287）, normal glucose tolerance patients with diabetic autonomic neuropathy （CAN group, n= 130） and healthy controls （NC group,n= 150）. Then the DM＋ CAN group were further divided into three subgroups according to age tertites： the lowest tertile group （35.0 ± 47.2 years old, n = 91）, the middle tertile group （47.3 ± 59.6 years old, n = 116） and the highest tertile group （59.7 ± 72. 3 years old, n = 80）. All subjects were underwent 24-hour dynamic electrocardiogram recordings. DC and Tp-e/QT values .were calculated, and then the correlation between DC and Tp-e/QT with other indicators was analyzed. Results The levels of WC, SBP, BMI, FPG, HbA1 c, Fins and HOMA-IR were higher in DM＋ CAN group than in CAN group and in NC group （P〈0.05 or P〈0.01）. DC increased and Tp-e/QT decreased from DM--CAN group, CAN group to NC group, and the pairwise comparisons were statistically significant （P〈0.05 or P〈 0.01）. DM duration,WC, FPG, Fins, HbA1 c, HOMA-IR, hypertension and CHD ratio were higher in the highest tertile group and middle tertile group than in the lowest tertile group （P〈0.05 or P-±0.01）. DM duration and Fins were higher in the highest tertile group than in middle tertile group （P〈0.05 or P〈 0.01）. RHR and AHR were lower in the highest tertile group than in the lowest tertile group （P〈0.05）, and there were no statistical significant difference between the middle tertile group and the lowest tertile group （P〈0.05）. DC increased [（2. 90±0. 47） vs （4. 22±0.41） vs （4.97±0.35） ms],and the Tp-e/QT decreased [（0.23±0.05） vs （0.18±0.03） vs （0.12±0.02）] from the highest tertile group to the lowest tertile group, （P±0.05 or P〈0.01）, and the pairwise comparisons were statistically significant （P〈0.05 or P〈 0.01）. Multiple stepwise regression analysis showed that age, DM duration, WC, FPG, HbA1 c, complicated with hypertension and coronary heart disease （CHD） were risk factors for DC and Tp-e/QT values （P〈0.05）. Conclusion Together with the increased age,DC level is reduced and Tp-e/QT value increased in patients with diabetic autonomic neuropathy. Dynamic electrocardiogram should be considered in patients with advanced age, long DM duration, high level of WC, FPG, HbA1 c, and complicated with hypertension and CHD, in order to prevent the occurrence of cardiovascular events effectively.