2型糖尿病肾病患者血糖波动与QTc间期相关性分析

Correlation analysis of glycemic variability and heart rate-corrected QT interval in patients with type 2 diabetic nephropathy

目的探讨2型糖尿病(T2DM)伴糖尿病肾病(DKD)患者血糖波动与经过心率校正的QT(QTc)间期的相关性。方法回顾性分析2018年1月—2020年1月在徐州医科大学附属医院住院确诊的300例T2DM患者的临床资料,根据有无肾脏并发症分为T2DM组75例和DKD组225例;根据预估肾小球滤过率(eGFR),将DKD组患者分为DKDⅠ组122例、DKDⅡ组41例、DKDⅢ组32例、DKDⅣ组30例。所有患者根据心电图结果估算QTc间期。最后将DKD组患者根据QTc间期四分位数分为QT1—4组进行统计分析,分析血糖波动与QTc间期的相关性。结果DKD组男性占比、饮酒史、年龄、糖尿病病程、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、血脂(TG)、QTc间期、血糖波动〔血糖标准差(SDBG)、最大血糖波动幅度(LAGE)、餐后血糖波动幅度(PPGE)〕、ST段压低发生率、胰岛素使用率均高于T2DM组(P<0.05)。在DKD组内随着eGFR下降,患者的QTc间期延长、血糖波动(SDBG、LAGE、PPGE)增大,相关性分析提示DKD组中血糖波动(SDBG、LAGE、PPGE)与QTc间期(r=0.477、0.450、0.351,P<0.05)呈正相关。多元Logistics回归分析提示SDBG是QTc间期延长的独立危险因素。结论随着DKD患者肾功能损伤加重,血糖波动(SDBG、LAGE、PPGE)有增加的趋势,QTc间期有延长的趋势,血糖波动(SDBG、LAGE、PPGE)与QTc间期呈正相关。SDBG是2型糖尿病肾病患者QTc间期延长的独立危险因素。

Objective To investigate the correlation between glycemic variability and heart rate-corrected QT(QTc)interval in type 2 diabetes mellitus(T2DM)patients with diabetic kidney disease(DKD).Methods A total of 300 T2DM patients who were admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to January 2020 were enrolled and their clinical data were retrospectively analyzed.According to the presence of renal complications,they were divided into two groups:a T2DM group(n=75)and a DKD group(n=225).According to estimated glomerular filtration rate(eGFR),patients in the DKD group were divided into four groups:a DKDⅠgroup(n=122),a DKDⅡgroup(n=41),a DKDⅢgroup(n=32)and a DKDⅣgroup(n=30).Then,QTc interval was estimated based on ECG results.Finally,according to QTc interval quartiles,patients in the DKD group were divided into QT1—4 groups,and the correlation between glycemic variability and QTc interval was analyzed.Results The DKD group presented remarkable increases in male percentage,alcohol drinking history,diabetes duration,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),triglycerides(TG),QTc interval,glycemic variability standard deviation of blood glucose(SDBG),the largest amplitude of glycemic excursion(LAGE),and postprandial glucose excursion(PPGE),the incidence of ST segment depression and insulin use rate,compared with the T2DM group(P<0.05).For the DKD group,with the decrease of eGFR,patients showed prolonged QTc interval and increases in glycemic variability(SDBG,LAGE,and PPGE).According to correlation analysis,glycemic variability(SDBG,LAGE,and PPGE)of the DKD group was positively correlated with QTc interval(r=0.477,0.450 and 0.351,P<0.05).Multiple logistic regression analysis showed that SDBG was an independent risk factor of QTc interval prolongation.Conclusions With the aggravation of DKD,patients present increases in glycemic variability(SDBG,LAGE,and PPGE)and prolonged QTc interval.Glycemic variability(SDBG,LAGE,and PPGE)is positively related to QTc interval.SDBG is an independent risk factor of QTc interval prolongation in T2DM patients.