老年糖尿病患者心脏自主神经功能对躯体功能和虚弱影响的研究

The effect of cardiac autonomic function on skeletal function and weakness in elderly diabetic patients

目的探讨老年糖尿病患者心脏自主神经功能对躯体功能和虚弱的影响。方法选取2017年8月至2018年8月在大连市友谊医院内分泌病房确诊为糖尿病心脏自主神经病变的患者共100例。记录入选患者的人口统计学、临床数据,日常生活能力量表(ADL)、使用器械生活活动能力量表(IADL)和虚弱评分,记录患者心率变异性的指标,以虚弱评分5分为界限,≥5分为虚弱组,<5分为非虚弱组。比较两组各指标的差异,将差异有统计学意义的变量为协变量,以虚弱评分为因变量,做协变量与因变量的直接和间接Logistic回归分析,并做受试者工作特征曲线(ROC曲线)。结果两组年龄、糖尿病病史、心率变异性中的全部正常窦性心搏RR间期的标准差(SDNN)和所有邻近窦性RR间期长度差异平方均值的平方根(SDANN)、三角指数,超低频率(ULF)、极低频率(VLF)、ADL、IADL比较差异有统计学意义(t=13.45,U=1700,t=-17.52,t=-18.34,U=1204.00,U=3407.56,t=17.90,t=21.89,t=12.21,P<0.05)。年龄、糖尿病病史、心率变异性中的SDNN、SDANN、三角指数、ULF、VLF、ADL、IADL是虚弱的独立影响因素(B=1.14、0.98、-0.46、-0.45、-0.79、0.57、0.53、-0.67、-0.79,P<0.05)。年龄、糖尿病病史、SDNN、SDANN、ULF、VLF可通过间接影响ADL/IADL进而影响虚弱评分(B=0.54/0.23,0.16/0.07,-0.34/-0.04,-0.54/-0.03,0.99/0.21,0.47/0.22,P<0.05)。SDNN、SDANN和ULF能够显著预测虚弱,约登最大值对应的敏感值分别为98 ms、97 ms和236 ms2/Hz。结论糖尿病心脏自主神经病变的患者如果年龄偏大,糖尿病病史较长,心率变异性指标中的SDNN大于98 ms,SDANN大于97 ms,ULF大于236 ms2/Hz的患者需进一步评估虚弱量表。

Objective To study the effect of cardiac autonomic nerve function on body function and weakness in elderly diabetic patients.Methods A total of 100 patients diagnosed as diabetic autonomic neuropathy in the endocrine ward of Dalian Friendship Hospital from August 2017 to August 2018 were enrolled.The demographics,clinical data,and Activities of Daily Living(ADL)scale of each patient were recorded,and the Instrument Activities of Daily Living(IADL)and the weak score were used to record heart rate variability in each patient.Aweak score of 5 was used as boundaries.Patients with weak score greater than or equal to 5 were divided into weak group,and those less than 5 were divided into non-weak groups.Each indicators were compared between the two groups.The statistically significant variables were used as covariates,and the weak scores were used as dependent variables to perform direct and indirect Logistic regression analysis of covariates and dependent variables and the receiver operation characteristic(ROC)curve.Results There were significant differences between the two groups in age,diabetes history,heart rate variability,standard deviation of NN intervals(SDNN),standard deviation of sinus RR interval every 5 min(SDANN),triangle index,ultralow frequency(ULF),very low frequency(VLF),activities of daily living(ADL),instrument activities of daily living(IADL)(t=13.45,U=1700,t=-17.52,t=-18.34,U=1204.00,U=3407.56,t=17.90,t=21.89,t=12.21,P<0.05).Age,diabetes history,heart rate variability,SDNN,SDANN,triangle index,ULF,VLF,ADL,IADL were independent factors of weakness(B=1.14,0.98,-0.46,-0.45,-0.79,0.57,0.53,-0.67,-0.79,P<0.05).Age,history of diabetes,SDNN,SDANN,ULF,VLF could affect the weak score by indirectly affecting ADL/IADL(B=0.54/0.23,0.16/0.07,-0.34/-0.04,,-0.54/-0.03,0.99/0.21,0.47/0.22,P<0.05).SDNN,SDANN and ULF could significantly predict weakness,and the sensitivity values of the Yuedeng index maximum were 98ms,97ms and 236 ms2/Hz,respectively.Conclusions Week score needs to be assessed in patients with diabetic autonomic neuropathy who have a long history of diabetes,and a DANN greater than 98 ms,a SDANN greater than 97 ms,and a ULF greater than 236 ms2/Hz in the heart rate variability index.