依帕司他对2型糖尿病合并冠心病患者HRV及炎性细胞因子的影响

Effects of epalrestat on heart rate variability and inflammatory cytokines in patients with type 2 diabetes mellitus complicated with coronary heart disease

目的探讨依帕司他对2型糖尿病(T2DM)合并冠心病(CHD)患者心率变异性(HRV)及炎性细胞因子水平的影响。方法 78例老年T2DM合并CHD患者随机分为观察组(n=39)和对照组(n=39),均给予常规对症治疗,观察组加服依帕司他片。分析24 h HRV相关参数变化,并检测炎性细胞因子及糖脂指标。结果两组治疗前HRV相关参数、炎性细胞因子及糖脂指标水平比较差异无统计学意义(P>0.05),治疗7 d、14 d各项HRV相关参数、炎性细胞因子及糖脂指标水平均较治疗前显著改善,差异有统计学意义(P<0.05);与对照组相比,观察组治疗14 d间期标准差(SDNN)、24 h内连续5 min节段平均正常R-R间距标准差(SDANN)、连续正常R-R间距差的均方根(r MSSD)、两个相邻R-R间距标准差≥50 ms的心搏数占所分析信息间期内心搏数的百分比(PNN50)、低频功率(LF)、高频功率(HF)均显著升高,LF/HF显著降低,差异有统计学意义(P<0.05);观察组血清白细胞介素-4(IL-4)、转化生长因子-β(TGF-β)显著高于对照组,肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)、空腹血糖(FBG)、糖化血红蛋白(Hb Alc)显著低于对照组,差异有统计学意义(P<0.05)。两组不良反应轻微,且均未见肝肾功能损害和血尿常规异常改变。结论依帕司他可显著改善T2DM合并CHD患者的HRV,减轻机体炎症反应,对血糖、血脂控制亦有一定的积极作用。

Objective To investigate the effects of epalrestat on 24 h heart rate variability（HRV） and inflammatorycytokines levels in patients with type 2 diabetes mellitus（T2 DM） complicated with coronary atherosclerotic heart disease（CHD）. Methods 78 cases of elderly patients with T2 DM complicated with CHD were randomly divided into theobservation group（n=39） and the control group（n=39）. The two groups were given hypoglycemic, lipid-lowering, anti-plateletand other conventional symptomatic treatments and the observation group was then treated with epalrestat tablets. Theparameters of 24 h HRV were analyzed by dynamic electrocardiogram analysis system, and the levels of inflammatorycytokines and glycolipid were measured before and after treatment. Results There was no significant difference in thelevels of HRV related parameters, inflammatory cytokines and glycolipid indexes between the two groups before treatment（P〉0.05）, and the levels of HRV parameters, inflammatory cytokines and glycolipid indexes of the two groups were significantlyimproved after 7 d or 14 d of treatment（P〈0.05）. But compared with the control group, the standard diviation of NN intervals（SDNN）, standard deviation of the average NN intervals calculated over 5 minutes within a 24-hour period（SDANN）, the rootmean square of adjacent R-R interval difference within 24 hours（r MSSD）,the percentage of adjacent NNR-R intervaldifference 〉50 ms within 24 hours（PNN50）, low frequency（LF） and high frequency（HF） were significantly increased and LF/HF was decreased significantly in the observation group after 14 d of treatment（P〈0.05）. The levels of serum interleukin-4（IL-4） and transforming growth factor-β（TGF-β） in the observation group after 14 d of treatment were significantly higherthan those of the control group, while the levels of tumor necrosis factor-α（TNF-α）, C-reactive protein（CRP）, fasting bloodglucose（FBG） and hemoglobin Alc（Hb Alc） were significantly lower（P〈0.05）. Adverse reactions were mild in the two groups,and there was no liver and kidney function injuries and abnormal hematuria routine changes. Conclusion Epalrestat couldsignificantly improve the HRV in patients with T2 DM complicated with CHD, reduce the inflammatory response of body, and have a positive effect on blood glucose and lipid control.