运动训练联合药物治疗对2型糖尿病心脏自主神经病变的影响研究

Study on effect of exercise training combined with drugs on cardiac autonomic neuropathy in type 2 diabetes mellitus

目的探讨运动对2型糖尿病患者心脏自主神经病变(CAN)的影响及心率恢复(HRR)的相关危险因素。方法选取确诊为2型糖尿病患者105例为研究对象,所有患者治疗前、后均行口服葡萄糖耐量试验和活动平板试验,分析导致HRR异常的相关危险因素。根据不同的治疗方案,将HRR异常分为普通治疗组和强化治疗组,普通治疗组应用二甲双胍辅并控制饮食,强化治疗组在此基础上接受轻度强化运动训练,对比两组患者治疗前、后的临床生化指标和HRR的变化情况。结果异常HRR与空腹血糖(FBG)、糖化血红蛋白(HbA1c)、静息心率、最大心率及收缩压(SBP)呈明显相关(P<0.05)。经过2个月的轻度强化运动训练后,普通治疗组和强化治疗组患者的FBG、HbA1c及静息心率较治疗前明显下降(P<0.05),HRR明显增加;与普通治疗组治疗后相比,强化治疗组治疗后的FBG、HbA1c、静息心率明显下降,HRR明显增加(P<0.05)。结论FBG、HbA1c、静息心率是影响2型糖尿病患者HRR异常重要的危险因素,轻度强化运动训练能够降低血糖水平,增加HRR,进而有效地改善CAN。

Objective To investigate the effect of exercise on the cardiovascular autonomic neuropathy （CAN） in type 2 diabetes mellitus（T2DM） and related risk factors of heart rate recover （HRR）. Methods One hundred and five patients with definitely diagnosed T2DM were selected as the research subjects.All patients underwent the oral glucose tolerance test and treadmill exercise test before and after treatment.The related risk factors leading to abnormal HRR were analyzed.Abnormal HRR was divided into the general therapy group （GT） and the intensive therapy group （IT） according to different treatment schemes.The GT group used metformin and diet control,whereas on this basis the IT group accepted the mild enhancement exercise training.The clinical biochemical indicators and HRR change before and after treatment were compared between the two groups. Results Abnormal HRR had significant correlation with FBG,HbA1c,resting heart rate,maximal heart rate and systolic blood pressure（SBP）（ P 〈0.05）.After two-month mild enhancement exercise training,FBG,HbA1c and resting heart rate in the GT group and IT group were significantly decreased compared with those before treatment（ P 〈0.05）,while HRR was significantly increased;compared with those after treatment in the GT group,the FBG,HbA1c levels and resting heart rate in the IT group were significantly decreased,while HRR was significantly increased（ P 〈0.05）. Conclusion FBG,HbA1c and resting heart rate are the important risk factors for abnormal HRR in T2DM patients,mild enhancement exercise training could reduce blood glucose level and increases HRR,thus effectively improve cardiac autonomic neuropathy.