冠心病合并2型糖尿病患者24h动态心电图监测结果及心脏结构状况分析

24h dynamic electrocardiogram monitoring and cardiac structure analysis in patients with coronary heart disease complicated with type 2 diabetes

目的研究冠心病合并2型糖尿病患者24 h动态心电图监测结果及心脏结构状况的变化,为患者的临床诊疗提供指导。方法选取渭南市第二医院2017年1月至2019年3月间收治的39例冠心病合并2型糖尿病患者(冠心病合并糖尿病组),37例2型糖尿病患者(糖尿病组)和38例冠心病患者(冠心病组)以及35例体检健康的志愿者(对照组)作为研究对象。检测所有受检者的24 h动态心电图并进行分析,同时进行心脏彩超检查,观察各自的心率变异性(HRV)的时域指标、昼夜节律变化,并对主要心功能指标进行对比分析。结果冠心病合并糖尿病组患者的HRV降低发生率为48.72%,明显高于对照组、冠心病组、糖尿病组的2.86%、28.95%、24.32%,差异均有统计学意义(P<0.05);冠心病合并糖尿病组患者清醒状态下正常窦性心搏R-R间期总体标准差(SDNN)、每5 min窦性R-R间期均值标准差(SDANN)、每5 min之间R-R间期标准差均值(SDNNindex),正常连续窦性R-R间期差值均方根(rMSSD)、相邻正常R-R间期差值>50 ms的心脏搏动数占总R-R间期数的百分比(pNN50)分别为(91.23±30.81)ms、(84.51±20.59)ms、(21.67±10.83)ms、(14.76±9.53)ms、(5.21±3.65)%,睡眠状态下分别为(98.51±29.76)ms、(88.68±19.16)ms、(19.24±10.95)ms、(17.31±10.71)ms、(4.86±3.42)%,清醒和睡眠状态之间比较差异均无统计学意义(P>0.05);冠心病组和糖尿病组患者的左心室射血分数(LVEF)、E峰A峰流速比值(E/A)分别为(67.81±6.53)%、(0.83±0.27)和(68.10±7.24)%、(0.82±0.23),明显高于冠心病合并糖尿病组患者的(59.98±4.67)%、(0.67±0.19),差异均有统计学意义(P<0.05);冠心病组和糖尿病组患者的左心房内径(LA)分别为(35.84±4.56)mm,(35.97±4.82)mm,均明显低于冠心病合并糖尿病组的(40.61±3.63)mm,差异均有统计学意义(P<0.05);冠心病组和糖尿病组患者的左心室舒张末期内径(LVEDD)分别为(47.90±4.89)mm,(48.14±5.07)mm,明显低于冠心病合并糖尿病组患者的(53.82±5.61)mm,差异均有统计学意义(P<0.05)。结论冠心病合并2型糖尿病患者的心脏自主神经系统损害程度为最高,HRV心率变异的昼夜节律变化无法检出,从HRV的指标变化可以有效判断患者心脏重构的程度和心脏功能的损害程度。

Objective To study the changes of 24 h dynamic electrocardiogram and cardiac structure in patients with coronary heart disease complicating type 2 diabetes,and to provide guidance for patients'clinical diagnosis and treatment.Methods Thirty-nine patients with coronary heart disease complicating type 2 diabetes mellitus,37 patients with type 2 diabetes,38 coronary heart disease patients,and 35 healthy volunteers(control group)from January 2017 to March 2019 in the Second Hospital of Weinan City were selected in the study.The 24 h dynamic electrocardiogram of all subjects was detected and analyzed.At the same time,echocardiography was performed to observe the time-domain index and circadian rhythm of heart rate variability(HRV),and the main cardiac function indexes were compared and analyzed.Results The incidence of HRV reduction in patients with coronary heart disease complicating type 2 diabetes was 48.72%,which was significantly higher than 2.86%in healthy volunteers,28.95%in patients with coronary heart disease,and 24.32%in patients with type 2 diabetes(P<0.05).The normal standard deviation of R-R interval in normal sinus beats(SDNN)within 24 hours,sinus R-R interval mean standard deviation(SDANN)every 5 minutes,R-R interval standard deviation mean(SDNNindex)every 5 minutes,normal continuous sinus R-R interval difference root mean square(rMSSD),percentage of heart beats between adjacent normal R-R interval>50 ms as a percentage of total R-R interval(pNN50)in the conscious state of patients with coronary heart disease complicating type 2 diabetes were(91.23±30.81)ms,(84.51±20.59)ms,(21.67±10.83)ms,(14.76±9.53)ms,(5.21±3.65)%,respectively.The SDNN,SDANN,SDNNindex,rMSSD,and pNN50 in the sleep state of patients with coronary heart disease complicating type 2 diabetes were(98.51±29.76)ms,(88.68±19.16)ms,(19.24±10.95)ms,(17.31±10.71)ms,(4.86±3.42)%,respectively,and there was no significant difference between the two groups(P>0.05).The left ventricular ejection fraction(LVEF)and E-peak A peak flow ratio(E/A)were(67.81±6.53)%,0.83±0.27 in patients with coronary heart disease and(68.10±7.24)%,0.82±0.23 in patients with type 2 diabetes,significantly higher than(59.98±4.67)%,0.67±0.19 in patients with coronary heart disease complicating type 2 diabetes(P<0.05).The left atrial diameter(LA)was(35.84±4.56)mm in the coronary heart disease group and(35.97±4.82)mm in the type 2 diabetes group,both significantly lower than(40.61±3.63)mm in the coronary heart disease complicating type 2 diabetes group(P<0.05).The left ventricular end diastolic diameter(LVEDD)was(47.90±4.89)mm in the coronary heart disease group and(48.14±5.07)mm in the type 2 diabetes group,both significantly lower than(53.82±5.61)mm in the coronary heart disease complicating type 2 diabetes group(P<0.05).Conclusion The degree of autonomic nervous system damage is the highest in patients with coronary heart disease complicating type 2 diabetes.The circadian rhythm of HRV heart rate variability can not be detected.The change of HRV index can effectively judge the degree of cardiac remodeling and the degree of cardiac function damage.