北京地区2型糖尿病患者糖尿病心脏自主神经病变现况调查

Investigation on the status of diabetic cardiac autonomic neuropathy in type 2 diabetic patients in Beijing

目的:调查北京地区2型糖尿病(T2DM)心脏自主神经病变(CAN)的患病率,探讨CAN的临床特点和发病危险因素。方法:本研究为多中心随机横断面研究。对2015年10月至2016年4月在北京市城区和郊区13家医院门诊就诊的T2DM患者,采用随机抽样的方法进行问卷调查、体格检查及实验室检查。根据心脏自主神经功能试验结果将患者分为CAN组及非CAN组。采用独立样本的t检验、秩和检验和χ2检验比较两组间计量资料和计数资料的差异。采用多因素logistic回归分析评估T2DM罹患CAN的危险因素。结果:纳入T2DM患者共1975例,CAN组患者1236例(62.6%),非CAN组患者739例(37.4%)。与非CAN组相比,CAN组患者年龄较大,病程较长,糖化血红蛋白较高,使用二甲双胍剂量较大,二甲双胍使用时间较长,接受高等教育的患者较少,合并冠心病、外周血管病变及高血压的患者更多,差异均有统计学意义(P<0.05)。与非CAN组T2DM患者比较,CAN组患者出现头晕和站立不稳、乏力、餐后饱腹感、尿频、夜尿、尿急和上半身出汗的自主神经病变症状更多,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄是CAN的独立危险因素(比值比为1.040,95%可信区间1.008~1.072,P=0.012)。结论:北京地区T2DM患者CAN的患病率较高,常合并多种自主神经病变症状,增龄是CAN的独立危险因素。

Objective To investigate the prevalence and explore the clinical characteristics and risk factors of diabetic cardiac autonomic neuropathy(CAN)in type 2 diabetic patients in Beijing.Methods This research is a multi-center,randomized,cross-sectional study.From October 2015 to April 2016,type 2 diabetes mellitus(T2DM)patients in 13 hospitals in the urban and suburban areas of Beijing were randomly sampled for questionnaire,physical examination and laboratory examination.Patients were divided into CAN group and non-CAN group according to the results of cardiovascular autonomic reflex tests(CART).The independent t test,the Wilcoxon rank-sum test and the chi-square test were used to compare the differences of continuous data and categorical data between the two groups.Multivariate logistic regression was used to analyze risk factors for CAN.Results A total of 1975 patients with T2DM were included,including 1236 patients(62.6%)in CAN group and 739 patients(37.4%)in non-CAN group.Compared with non-CAN group,CAN group had older age,longer duration of diabetes,higher glycated hemoglobin A1c,larger metformin dosage,longer metformin medication time,fewer patients receiving higher education,and more complicated with coronary heart disease,peripheral vascular disease and hypertension(P<0.05).The most common manifestations of CAN included dizziness,standing instability,weakness,postprandial fullness,frequent urination,nocturia,urgent urination and upper body sweating(P<0.05).Logistic regression analysis showed that age was an independent risk factor for CAN in T2DM patients(OR=1.040,95%CI 1.008 to 1.072,P=0.012).Conclusions The prevalence of CAN in patients with type 2 diabetes in Beijing is high.CAN is often associated with a variety of autonomic neuropathy symptoms and age is an independent risk factor for CAN.