2型糖尿病合并原发性高血压患者心率减速力及连续心率减速力分析

The analysis of deceleration capacity of rate and heart rate deceleration runs in patients with type 2diabetes mellituswith essential hypertension

目的探讨2型糖尿病合并原发性高血压患者心率减速力(DC)与连续心率减速力(DRs)的变化及其与胰岛素抵抗(IR)的关系和临床意义。方法选择45例2型糖尿病(T2DM组)和90例2型糖尿病合并原发性高血压(T2DM+HT组)患者,另选45例正常体检者为对照组,三组均进行相关生化和代谢等指标及动态心电图检测,测量DC、DRs(DR2、DR4、DR8分别为连续2、4和8个心动周期相继发生心率减速现象)及心率变异性(HRV)等相关指标值,比较三组各指标的变化。结果 (1)T2DM组和T2DM+HT组的DC、DR2、DR4、DR8、24h正常窦性RR间期的标准差(SDNN)、全程相邻正常R-R间期之差的均方根(RMSSD)值均小于对照组(P分别<0.05或0.01),平均心率(AHR)、心率加速力(AC)高于对照组(P均<0.01);(2)与T2DM组比较,T2DM+HT组DC值也显著降低(P<0.05)。(3)T2DM+HT组DC与DR2、DR4、DR8、SDNN、RMSSD呈明显正相关,与空腹血糖(FBG)、糖化血红蛋白(HbA1C)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、AC、AHR呈明显负相关(P均<0.05或0.01)。(4)T2DM+HT组HbA1C与DC、DR2、DR4、SDNN、RMSSD呈明显负相关,与AC和AHR呈明显正相关(P均<0.05或0.01);HOMA-IR与DC、DR2、DR4、DR8、SDNN呈明显负相关,与AC、HbA1C呈明显正相关(P均<0.05或0.01)。结论 2型糖尿病合并原发性高血压患者的自主神经功能受损明显,IR加重,DC值与DRs检测可作为其定量评估新的较好指标。

Objective To investigate the changes of deceleration capacity of rate（DC） and heart rate deceleration runs（DRs ） in patients suffering from type 2 diabetes mellitus （T2DM） with essential hypertension and to explore the correlation between them and insulin resistance（IR）. Methods Forty-five cases of T2DM（T2DM group） and 90 cases of T2DM with essential hypertension（T2DM ＋ HT group） as the experimental group, 45 cases of normal physical examination as a control group were recruited.The related biochemical and metabolic index of three group patients were measured, All patients were monitored with dynamic electrocardiogram. D C, DRs（DR2, DR4, and DR8, i.e., episodes of 2, 4, or 8 consecutive beat-to-beat heart rate decelerations, respectively） and heart rate varia- bility （HRV） and other relevant indexes were determined, the index changes of three groups were compared. Re- suits ①T2DM and T2DM ＋ HT group of DC, DR2, DR4 ,DR8 values, standard deviation of all normal-to-normalsinus RR intervals over 24 h （SDNN）, root mean square of the successive normal sinus RR interval difference（RMSSD） were decreased significantly than that of control group （P〈0.05 and 0.01）, the average heart rate （AHR）, acceleration capacity of rate（AC） were increased significantly than that of control group （P 〉0.01） ②Compared with T2DM group, DC valueof T2DM ＋ HT group also decreased significantly （P〈 0.05） ; ③ In T2DM ＋ HT group, DC and DR2 , DR4 , DR8, SDNN,RMSSD was significantly positive correlation ; and significantly negative correlated to the fasting blood glucose （FBG）, glycosylated hemoglobin Ale （HbA1c）, homeostasis model assessment-insulin resistance index （HOMA- IR） ,triglyceride （TG）, AC, AHR（ P 〈0.05 and 0.01, respectively）. ④In T2DM ＋ HT group, HbA1c and DC,DR2 ,DR4 ,SDNN,RMSSD was significantly negative correlation, and significantly positive correlated with AC and AHR （P〈0.05 and 0.01） ; HOMA-IR and DC, DR2, DR4, DR8 ,SDNN was significantly negative correla- tion , and significantly positive correlated with AC, HbA1c （Pal0.05 and 0.01, respectively）. Conclusions In T2DM with essential hypertension patients, the autonomic nervous function is damaged with the insulin resistance, the DC and DRs detection can be used as noninvasive good tool to assess cardiac autonomic function.