2型糖尿病合并冠状动脉硬化患者心率变异性与中医证型相关性分析

Analysis of the correlation between heart rate variability and TCM syndromes in patients with type 2 diabetes mellitus complicated with coronary atherosclerosis

目的:探讨2型糖尿病合并不同程度冠状动脉硬化患者心率变异性与中医辨证分型的相关性。方法:回顾性分析成人2型糖尿病患者中行动态心电图检查的患者进行分组,单纯2型糖尿病组(糖尿病组)102例为对照组,2型糖尿合并冠状动脉硬化组(冠状动脉硬化组)84例,2型糖尿病合并冠心病组(冠心病组)81例。采用3导7电极记录器行24 h长程采样检测HRV时域及频域指标,并辨证分型为气阴两虚、阴阳两虚、湿热内蕴、血脉瘀阻四组证型。比较三组间心率变异性(HRV)时域和频域指标、四组证型的差异以及两者的相关性。结果:三组间糖尿病病程、体重指数(BMI)、糖化血红蛋白(HbA1c)、促甲状腺激素(TSH)、心脏射血分数(EF)值比较,差异无统计学意义(P>0.05)。与糖尿病组比较,冠状动脉硬化组及冠心病组的SDNN、SDANN、W、LF、LF/HF均较糖尿病组下降,差异有统计学意义(P<0.05);冠状动脉硬化组与冠心病组下降程度相当,差异无统计学意义(P>0.05)。2型糖尿病合并不同冠脉硬化程度辨证分型,分为气阴两虚、阴阳两虚、湿热内蕴、血脉瘀阻四组证型例数分别在三组进行比较,与糖尿病组比较,湿热内蕴证在冠状动脉硬化组及冠心病组所占比例较低,且冠心病组低于冠状动脉硬化组;血脉瘀阻证在冠心病组所占比例较高,且冠心病组高于冠状动脉硬化组,差异有统计学意义(P<0.05),其余两组证型差异无统计学意义(P>0.05)。Pearson结果显示,三组间心率变异性与气阴两虚、阴阳两虚两证型无相关性,湿热内蕴证与SDNN(r=0.211,P=0.001)、W(r=0.185,P=0.002)、LFP(r=0.212,P=0.001)呈正相关;血脉瘀阻证与SDNN(r=-0.175,P=0.004)、W(r=-0.123,P=0.044)、LFP(r=-0.15,P=0.014)呈负相关。结论:2型糖尿病患者中,不论冠状动脉硬化的严重程度均可增加心率变异性下降的风险;冠状动脉硬化程度越高,血脉瘀阻证占比越高,湿热内蕴证占比越低。在2型糖尿病合并不同程度冠状动脉硬化患者中心率变异性与湿热内蕴证呈正相关、与血脉瘀阻证呈负相关,HRV下降程度越明显,血瘀的表现越突出,相反湿热证表现越少。

Objective:To investigate the relationship between heart rate variability and TCM syndrome differentiation in patients with type 2 diabetes mellitus complicated with different degrees of coronary artery sclerosis.Methods:Adult patients with type 2 diabetes patients with boc dynamic ecg examination for grouping,simple type 2 diabetes mellitus group(diabetes group)102 cases as control group,type 2 diabetes merge coronary atherosclerosis group(coronary atherosclerosis group)84 cases,group type 2 diabetes mellitus and coronary heart disease(CHD)in 81 cases.A 3-conductor 7-electrode recorder was used for 24 h long range sampling to detect HRV indicators in time and frequency domain.The syndrome types were divided into four groups:Qi and Yin deficiency,Yin and Yang deficiency,dampness-heat accumulation,and blood stasis.The differences of HRV in time domain and frequency domain,syndrome types and their correlation were compared among the three groups.Results:There was no significant difference in the course of diabetes,BMI,HbA1c,TSH and EF among the three groups(P>0.05).Compared with diabetic group,SDNN,SDANN,W,LFP,LF/HF in coronary arteriosclerosis group and coronary heart disease group were significantly lower than those in diabetic group(P<0.05).There was no significant difference between coronary arteriosclerosis group and coronary heart disease group(P>0.05).The degree of decline was comparable in the coronary atherosclerosis group and the coronary heart disease group.Type 2 diabetes mellitus and of different degree of hardening of the arteries,divided into two virtual,Yin and Yang,qi and Yin deficiency of four groups,hot and humid embodiment,blood stasis resistance syndrome cases compared with three groups respectively,compared with diabetes group,dampness-heat accumulation in the group of coronary atherosclerosis and coronary heart disease(CHD)proportion is low,and coronary heart disease group is lower than the coronary atherosclerosis;The proportion of blood stasis syndrome in the coronary heart disease group was higher,and the coronary heart disease group was higher than the coronary artery sclerosis group,with statistical significance(P<0.05),while the other two groups had no statistical significance(P>0.05).Pearson’s results showed that there was no correlation between heart rate variability and syndrome types of Qi and Yin deficiency and Yin and Yang deficiency.The syndrome of dampness-heat accumulation was associated with SDNN(r=0.211,P=0.001),W(r=0.185,P=0.002),LFP(r=0.212,P=0.212.P=0.001).Blood stasis syndrome was negatively correlated with SDNN(r=-0.175,P=0.004),W(r=-0.123,P=0.044)and LFP(r=-0.15,P=0.014).Conclusion:In patients with type 2 diabetes mellitus,regardless of the severity of coronary atherosclerosis,the risk of decreased heart rate variability is increased.The higher the degree of coronary artery stiffness,the higher the proportion of blood stasis syndrome and the lower the proportion of dampness-heat syndrome.In patients with type 2 diabetes mellitus complicated with different degrees of coronary artery sclerosis,the variability of center rate is positively correlated with dampness-heat syndrome and negatively correlated with blood stasis syndrome.The more obvious the decrease of HRV is,the more prominent the blood stasis,while the less dampness-heat syndrome.