2型糖尿病合并冠心病患者心率变异性变化及其与心功能的相关性分析

Changes of heart rate variability in type 2 diabetes mellitus patients complicating with coronary heart disease and its correlation with cardiac function

目的分析2型糖尿病(T2DM)合并冠心病患者心率变异性(HRV)变化及其与心功能的相关性。方法选取未合并冠心病的T2DM患者58例(T2DM组)、T2DM合并冠心病患者40例(T2DM合并冠心病组)、健康志愿者30例(对照组)作为研究对象,分析HRV参数[24 h正常R-R间期标准差(SDNN)、全程相邻RR间期差值的均方根(rMSSD)、全部相邻的RR间期差值大于50 ms的百分数(PNN50)、极低频功率(VLF)、低频功率(LF)、高频功率(HF)]与心功能分级、冠状动脉(简称冠脉)病变程度的相关性。结果T2DM组、T2DM合并冠心病组SDNN、rMSSD、PNN50、VLF、LF、HF低于对照组,T2DM合并冠心病组SDNN、rMSSD、PNN50、VLF、LF、HF低于T2DM组,差异有统计学意义(P<0.05);随着美国纽约心脏病学会(NYHA)分级升高、冠脉病变支数增加,SDNN、rMSSD、PNN50、HF下降,差异有统计学意义(P<0.05);T2DM合并冠心病患者SDNN、rMSSD、PNN50、HF均与NYHA分级呈显著负相关(P<0.05),rMSSD、PNN50、HF均与冠脉病变程度呈显著负相关(P<0.05)。结论T2DM合并冠心病患者HRV各参数呈下降趋势,且SDNN、rMSSD、PNN50、HF与心功能相关,rMSSD、PNN50、HF与冠脉病变严重程度相关。

Objective To analyze the changes of heart rate variability(HRV)in type 2 diabetes mellitus(T2DM)patients complicating with coronary heart disease(CHD),and its correlation with cardiac function.Methods Totally 58 patients with T2DM but without CHD(T2DM group),40 patients with T2DM and CHD(T2DM with CHD group),and 30 healthy volunteers(control group)were selected as research subjects.The correlations of HRV parameters[24 h standard deviation of normal R-R intervals(SDNN),root mean sum of the squared differences between R-R intervals(rMSSD),percetange of adjacent NN intervals differing by more than 50 ms(PNN50),very low frequency(VLF),low frequency(LF),high frequency(HF)]with the grade of cardiac function and the severity of coronary artery lesions were analyzed.Results The SDNN,rMSSD,PNN50,VLF,LF and HF were lower in the T2DM group and the T2DM with CHD group than those in the control group,and lower in the T2DM with CHD group than those of the T2DM group(P<0.05).With the increase of New York Heart Association(NYHA)grade and the number of coronary artery lesions,SDNN,rMSSD,PNN50 and HF decreased,with statistically significant differences(P<0.05).SDNN,rMSSD,PNN50 and HF were negatively correlated with NYHA grade in the T2DM with CHD group(P<0.05).The rMSSD,PNN50 and HF were negatively correlated with the severity of coronary artery lesions(P<0.05).Conclusion HRV parameters show a decreasing trend in patients with T2DM and CHD.SDNN,rMSSD,PNN50 and HF are related to cardiac function,while rMSSD,PNN50 and HF are related to the severity of coronary artery lesions.