2型糖尿病患者心率变异性与尿白蛋白/肌酐比值的相关性研究

The relationship between heart rate variability and urine albumin/creatinine ratio in patients with type 2 diabetes

目的探讨2型糖尿病患者心率变异性(heart rate variability,HRV)与尿白蛋白/肌酐比值(albumin/creatinine ratio,ACR)的关系。方法选取上海交通大学医学院附属新华医院内分泌科住院的1543例2型糖尿病患者进行24 h动态心电图监测及ACR测定,HRV参数包括正常间隔到正常间隔的标准差(standard deviation of all normal to normal intervals,SDNN)、相临RR间期之差的均方根值(root mean square differences of successive RR intervals,rMSSD)、相邻RR间期相差>50 ms的数量占总心搏数的百分比(the percent of adjacent RR intervals with a difference greater than 50 ms,PNN50)、低频(low frequency,LF)、高频(high frequency,HF)、LF与HF的比值(LF/HF)。多元线性回归分析HRV与ACR的关系。将HRV参数分为≤25%(Q1)与≥25%(Q2~Q4)两组,分析其与白蛋白尿的关系。结果多元线性回归显示,HRV参数[ln(SDNN)、ln(PNN50)、ln(LF)、ln(HF)、ln(LF/HF)]减低与ln(ACR)的增加密切相关(均P<0.05)。Logistic回归分析显示,SDNN(OR=1.669,95%CI 1.290~2.159)、PNN50(OR=1.372,95%CI 1.063~1.770)、LF(OR=1.918,95%CI 1.441~2.551)、LF/HF(OR=1.623,95%CI 1.220~2.183)在Q1组发生白蛋白尿的风险较Q2~Q4组更高(均P<0.05);进一步按病程中位数(10年)、心血管疾病分层进行多因素logistic回归分析,在糖尿病病程≤10年或未合并心血管疾病患者中,SDNN和LF的Q1组有更高的发生白蛋白尿的风险,而在糖尿病病程>10年或合并心血管疾病患者中,SDNN、PNN50、LF和LF/HF的Q1组有更高的发生白蛋白尿的风险。结论2型糖尿病患者中HRV参数减低与ACR升高密切相关,且随着糖尿病的进展,HRV分析中有更多参数的减低增加白蛋白尿的发生风险。

Objective To explore the relationship between heart rate variability(HRV)and urine albumin/creatinine ratio(ACR)in patients with type 2 diabetes.Methods A total of 1543 patients with type 2 diabetes were selected from the Department of Endocrinology of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,and all the participants received 24-hour Holter monitoring and ACR measurement.HRV parameters include the standard deviation of all normal to normal intervals(SDNN),root mean square differences of successive RR intervals(rMSSD),the percent of adjacent RR intervals with a difference greater than 50 ms(PNN50),low frequency(LF),high frequency(HF),the ratio of LF to HF(LF/HF).Multivariate linear regression was used to analyze the relationship between HRV and ACR.Logistic regression was performed to further analyze the relationship between HRV and albuminuria while HRV parameter was divided into≤25%(Q1)and≥25%(Q2-Q4).Results Multivariate linear regression results showed that the decrease of HRV parameters[ln(SDNN),ln(PNN50),ln(LF),ln(HF),ln(LF/HF)]was closely related to the increase of ln(ACR)(all P<0.05).Logistic regression analysis results showed that SDNN(OR=1.669,95%CI 1.290-2.159),PNN50(OR=1.372,95%CI 1.063-1.770),LF(OR=1.918,95%CI 1.441-2.551),and LF/HF(OR=1.623,95%CI 1.220-2.183)were independent risk factors for albuminuria(all P<0.05);Furthermore,logistic regression analysis stratified by the median duration of diabetes(10 years)and cardiovascular disease found that in patients with diabetes≤10 years or without cardiovascular disease,the risk of albuminuria in the SDNN and LF Q1 group were higher than that in the Q2-Q4 group;while in patients with diabetes>10 years or with cardiovascular disease,the risk of albuminuria in the SDNN,PNN50,LF,and LF/HF Q1 group were higher than that in the Q2-Q4 group.Conclusion The reduction of HRV parameters in patients with type 2 diabetes is closely related to the increase of ACR.With the progress of diabetes,more HRV parameters demonstrated predictive effect for risk of albuminuria.