2型糖尿病患者心血管自主神经病变与夜间无症状低血糖程度的关系

Association between cardiovascular autonomic neuropathy and severity of nocturnal asymptomatic hypoglycemia in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者心血管自主神经病变(CAN)与夜间无症状低血糖及低血糖程度的关系。方法选择2019年1月至2020年12月绍兴市人民医院就诊的T2DM患者60例,男32例,女28例,根据Ewing试验(深呼吸时RR间期变异率、卧立位收缩压差、Valsalva动作RR间期变异率、卧立位30/15 RR间期比值)评分分为CAN组和无CAN组。采用回顾性动态血糖监测(CGM)连续监测72 h,记录患者无症状低血糖发生事件(葡萄糖≤3.5mmol/L为低血糖,按低血糖程度进一步分层,葡萄糖<3 mmol/L为临床显著低血糖)。采用独立样本t检验和卡方检验分析夜间无症状低血糖和低血糖程度与CAN的关系,采用Logistic二元回归分析临床显著低血糖的危险因素。结果与无CAN组相比,CAN组夜间无症状低血糖发生率显著升高,临床显著低血糖发生率明显升高,差异均具有统计学意义(χ^(2)=4.115、6.429,P<0.05);CAN组同一患者发生2次及以上的夜间无症状低血糖发生率明显高于非CAN组(χ^(2)=4.662,P<0.05);Logistic二元回归分析结果显示,CAN是临床显著低血糖的危险因素[OR(95%CI)=2.451(0.821~4.421),P<0.05]。结论CAN是T2DM患者发生临床显著低血糖的危险因素,早期筛查CAN有助于减少无症状低血糖相关的心血管不良事件。

Objective To explore the correlation between cardiovascular autonomic neuropathy(CAN)and asymptomatic nocturnal hypoglycemia and severity of hypoglycemia in type 2 diabetes mellitus(T2DM)patients.Methods A total of 60 T2DM patients(32 males,28 females)in Shaoxing People’s Hospital between January 2019 and October 2020 were enrolled,and divided into CAN group and non-CAN group according to Ewing test,including heart rate variation during deep breathing,systolic blood pressure responses to lying-to-standing position,Valsalva maneuver and lyingto-standing test(30:15 ratio).Retrospective continuous glucose monitoring(CGM)was used for 72hours,and the asymptomatic hypoglycemia episodes were recorded(glucose≤3.5mmol/L was defined hypoglycemia,and glucose<3mmol/L was defined clinically severe hypoglycemia).Independent-sample t test and chi-square test were introduced to analyze the correlation between CAN and asymptomatic nocturnal hypoglycemia and severity of hypoglycemia in T2DM.The risk factors of clinically significant hypoglycemia were analyzed by Logistic binary regression.Results Compared with the non-CAN group,the incidence of asymptomatic nocturnal hypoglycemia was significantly higher in CAN group,and the incidence of clinically significant hypoglycemia significantly increased(χ^(2)=4.115,6.429;P<0.05).In addition,patients with CAN had higher incidence of two or more episodes of asymptomatic hypoglycemia compared with the non-CAN group(χ^(2)=4.662,P<0.05).Logistic binary regression analysis showed that CAN was a risk factor of clinically significant hypoglycemia[OR(95%CI)=2.451(0.821-4.421),P<0.05].Conclusion CAN is a risk factor of clinically severe hypoglycemia in patients with T2DM,which suggests that early screening of CAN is helpful to reduce the incidence of cardiovascular adverse events associated with asymptomatic hypoglycemia.