心率变异性对糖尿病前期患者心血管事件预测价值的观察

Predictive value of heart rate variability for cardiovascular events in patients with pre-diabetes

目的探讨心率变异性(HRV)时域、频域指标对糖尿病前期(pre-DM)患者心血管事件的预测价值。方法选取2010年2月至2012年5月于山东邹城兖矿新里程总医院内分泌科门诊就诊的pre-DM患者(pre-DM组)122例及我院体检健康人员80名(NC组),比较两组HRV时域、频域指标变化情况,随访6年并评估HRV对远期心血管事件的预测价值。结果pre-DM组BMI、FPG、2 h PG、C-P、FIns、LDL-C、HDL-C、TG、TC、HbA1c、胰岛素抵抗指数(HOMA-IR)及高敏C反应蛋白(hsC-RP)均高于NC组,而正常R-R间期的标准差(SDNN)、5 min平均心率的标准差(SDANN)、总频谱(TF)、低频、高频等指标均低于NC组(P<0.05或P<0.01);pre-DM组99例患者完成随访,其中31例(31.31%)进展为T2DM且SDNN、SDANN低于其他患者(P<0.05),将pre-DM组按照是否发生心血管并发症分为心血管事件组(n=18)和无心血管事件组(n=81),心血管事件组SDANN低于无心血管事件组(P<0.05);SDANN预测心血管事件的曲线下面积为0.799(95%CI 0.659~0.907,P=0.034),诊断临界值为71 ms,对应的灵敏度、特异性为81.36%、86.90%。以SDANN临界值进行分组比较,结果显示,SDANN<71 ms患者心血管事件累积发生率显著高于SDANN≥71 ms患者(Log rankχ2=21.181,P<0.01);Logistic回归分析结果显示,TC、HbA1c、HOMA-IR、hsC-RP为心血管事件的危险因素,SDNN、SDANN、TF为心血管事件的保护因素(P<0.05)。结论HRV时域、频域指标对pre-DM患者远期心血管事件有一定预测价值。

Objective To explore the predictive value of time-domain and frequency-domain indices of heart rate variability for cardiovascular events in patients with pre-diabetes mellitus.Methods A total of 122 patients with pre-diabetes mellitus(pre-DM group)and 80 healthy persons(NC group)were enrolled in this study from outpatient clinic in Endocrinology Department in Yankuang Xin Licheng Hospital in Zoucheng,Shandong Province from Feb 2010 to May 2012. The changes of heart rate variability(HRV)in time domain and frequency domain were compared between the two groups. Then all the participants were followed up for 6 years and evaluate the predictive value of HRV for long-term cardiovascular events.Results BMI,FPG,2 h PG,C-P,Fins,LDL-C,HDL-C,TG,TC,HbA1 c,HOMA-IR and hsC-RP were higher,while the standard deviation of positive R-R interval(SDNN),standard deviation of 5-minute average heart rate(SDANN),total frequency(TF),low frequency,high frequency were lower in pre-DM group than in NC group. In pre-DM group,99 patients completed follow-up,of which 31(31. 31%)developed to type 2 diabetes mellitus(T2 DM),and the levels of SDNN and SDANN were lower in T2 DM group than in pre-DM group(P<0. 05). The pre-DM group was further divided into two subgroups according to the occurrence of cardiovascular complications:subgroup with cardiovascular events(n=18)and subgroup without cardiovascular events(n=81). SDANN was lower in the group with cardiovascular events than in the group without cardiovascular events(P<0. 05). The area under curve(AUC)of SDANN for predicting cardiovascular events was 0. 799(95% CI 0. 659~0. 907,P=0. 034),and the diagnostic threshold was 71 ms,and the corresponding sensitivity and specificity were 81. 36% and 86. 90% respectively. Grouped by SDANN threshold,the result showed that the cumulative incidence of cardiovascular events was significantly higher in SDANN<71 ms group than in SDANN< 71 ms group(Log rankχ2=21. 181,P<0. 001). Logistic regression analysis showed that TC,HbA1 c,HOMA-IR and hsC-RP were risk factors for cardiovascular events,while SDNN,SDANN,TF were protective factors for cardiovascular events(P<0. 05).Conclusion The time-domain and frequency-domain indexes of heart rate variability have certain predictive value for longterm cardiovascular events in pre-diabetic patients.