2型糖尿病患者自主神经功能与肾小球滤过率的相关性

The relationship between autonomic nervous function and glomerular filtrationrate in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者自主神经功能与肾功能的相关性。方法选取2013年1月至2015年12月在我院住院治疗的2型糖尿病患者92例,并筛选出同期在我院体检中心观察的健康人85例为对照组,所有对象均进行无创性24 h动态血压及动态心电图监测,记录心率变异性(HRV)和血压变异性(BPV)指标。同时测定血肌酐,计算肾小球滤过率(GFR)估测值(eGFR)。结果与正常对照组相比,糖尿病组血肌酐及肾小球滤过率估测值(eGFR)的水平明显升高(P﹤0.05),糖尿病组的心率变异指标(SDANN、nHR/dHR)与血压变异指标(24h SBP、nSBP、24h SCV)与对照组比较差异亦有统计学意义(P﹤0.05)。Pearson相关分析显示:肾小球滤过率估测值(eGFR)的水平与nHR/dHR、24h SBP、nSBP、24h SCV均呈显著负相关,与SDANN呈正相关。多元Logistic回归分析显示:nHR/dHR、24h SBP、24h SCV与eGFR均呈显著负相关性(P﹤0.05)。结论糖尿病患者存在心率变异及血压变异的指标异常,提示糖尿病患者存在自主神经功能改变,自主神经功能改变可能参与了糖尿病肾病的发生、发展机制,是糖尿病肾病发生的危险因素。

Objective：To investigate the relationship between autonomic nervous function and renal function in patients with type 2 diabetes mellitus.Methods：Ninety-two patients with type 2 diabetes and 85 normal controls were selected from January 2013 to December 2015 in our hospital hospitalized patients.The 92 patients were diagnosed according to the international standard.The 85 normal controls were selected from the physical examination center.All objects were monitored for 24 h ambulatory blood pressure and dynamic electrocardiogram.Heart rate variability（HRV） and blood pressure variability（BPV） were recorded.Serum creatinine was measured and estimated and glomerular filtration（GFR） rate（EGFR） was calculated.Results：The serum creatinine and the estimated value of glomerular filtration rate（EGFR） in the diabetic group were significantly increased compared with the normal control group（P0.05）.The heart rate variability（SDANN,nHR/dHR） and blood pressure variability（24 h SBP,nSBP,24 h SCV） in diabetic group were also significantly different from those in control group（P0.05）.Pearson correlation analysis showed that the levels of eGFR were negatively correlated with nHR/dHR,24 h SBP,nSBP and 24 h SCV.positively correlated with SDANN.Multiple stepwise regression analysis showed that the level of eGFR were negatively correlated with nHR/dHR,24 h SBP and 24 h SCV（P0.05）.Conclusions：The abnormal indexes of heart rate variation and blood pressure variation in the diabetic patients suggest that the diabetic patients have the change of autonomic nervous function.The change of autonomic nervous function may be involved in the pathogenesis and development of diabetic nephropathy,and it is a risk factor of diabetic nephropathy.