2型糖尿病患者心脏自主神经病变与夜间低血糖的关系

Relationship between cardiac autonomic neuropathy and nocturnal hypoglycemia in type 2 diabetes

目的探讨2型糖尿病（T2DM）患者心脏自主神经病变（CAN）与夜间低血糖之间的关系。方法收集76例T2DM患者的临床资料，通过完善心血管反射试验判定其是否存在CAN，同时采用动态血糖监测系统（CGMS）监测全天血糖变化并记录夜间低血糖发生情况，根据有无CAN将76例患者分为CAN组和无CAN组，再根据有无夜间低血糖将其分为夜间低血糖组和无夜间低血糖组，分别比较两组患者的临床资料并进行分析。结果入组患者中合并CAN者36例，占47．4％；与无CAN组比较，CAN组患者年龄较大、糖尿病病程较长，差异均有统计学意义（P〈0．05），而两组间糖化血红蛋白（HbA1c）水平比较差异无统计学意义（P〉0．05）。发生夜间低血糖者27例，占35．5％；夜间低血糖组与无夜间低血糖组患者年龄、糖尿病病程和HbA1c水平比较差异均无统计学意义（P〉0．05）。CAN组患者夜间低血糖的发生率（55．6％）明显高于无CAN组（17．5％，P〈0．01）；夜间低血糖发生组患者CAN的患病率（74．1％）明显高于无夜间低血糖发生组（32．7％，P〈0．01）。结论T2DM患者CAN和夜间低血糖的发生存在相关性，提示对于合并CAN的T2DM患者应加强夜间血糖监测，而对于有夜间低血糖发生的患者应早期筛查CAN，避免夜间低血糖的发生。

Objective To investigate the relationship between cardiac autonomic neuropathy （CAN） and nocturnal hypoglycemia in patients with type 2 diabetes （T2DM）. Methods Seventy six hospitalized T2DM patients were enrolled and clinical data were collected. CAN was diagnosed by cardiovascular reflex tests and nocturnal hypoglycemia was diagnosed by continuous glucose monitoring system（ CGMS）. The patients were divided into CAN group and non-CAN group according to whether they had CAN. They were also divided into hypoglycemia group and non-hypoglycemia group according to whether they had nocturnal hypoglycemia. Results The prevalence of CAN was 47.4% （ 36/76 ）. Compraed with non-CAN group, age and the course of diabetes were obviously higher in CAN group, while glycosylated hemoglobin（HbAlc） in two groups were not significantly different（P 〉0.05 ）. The prevalence of nocturnal hypoglycemia was 35.5% （ 27/76 ）. Compraed with non-hypoglycemia group, age, the course of diabetes and HbA1 c in two groups were not significantly different（ P 〉 0.05 ）. Compared with non-CAN group, the incidence of nocturnal hypoglycemia in CAN group was significantly higher（55.6% vs 17.5 % , P 〈 0.01 ）. Compared with non-hypoglycemia group, the prevalence of CAN in nocturnal hypoglycemia group was significantly higher（ 74.1% vs 32.7% ,P 〈 0.01 ）. Conclusion There might be a relationship between CAN and nocturnal hypoglycemia in T2DM. T2DM patients who complicated with CAN should be monitored blood glucose intensely during night. In addition, the patients who had nocturnal hypoglycemia shoud have CAN screening in order to prevent the occurrence of nocturnal hypoglycemia.