糖尿病心脏自主神经病变发病危险因素及与糖化血红蛋白指数的关系

Risk Factors of Diabetic Cardiac Autonomic Neuropathy and Its Relationship with Hemoglobin Glycation Index

目的探讨糖尿病心脏自主神经病变(DCAN)发病危险因素及与糖化血红蛋白指数(HGI)的关系。方法回顾性分析2017年1月至2021年1月安徽医科大学附属安庆第一人民医院收治的497例2型糖尿病患者的临床资料,依据是否发生DCAN分为DCAN组(147例)和非DCAN组(350例),比较两组患者的一般资料和实验室检查指标,采用Logistic回归模型分析DCAN发病的独立危险因素。结果DCAN组年龄、糖尿病家族史、血脂异常、空腹血糖(FPG)、糖化血红蛋白(HbA_(1c))、高敏C反应蛋白(hs-CRP)、尿白蛋白/肌酐比值(UACR)、HGI水平均显著高于非DCAN组(P<0.05或P<0.01),三酰甘油(TG)、深呼气最大心率与深吸气最小心率间差值及瓦氏试验R-R比值均低于非DCAN组(P<0.01)。多因素Logistic回归分析结果显示,HGI、糖尿病家族史、FPG、HbA_(1c)、hs-CRP、UACR及血脂异常均是DCAN发病的独立影响因素(OR=2.061,95%CI 1.833~2.865;OR=1.719,95%CI 1.501~1.949;OR=1.543,95%CI 1.013~2.106;OR=2.042,95%CI 1.545~2.931;OR=2.305,95%CI 1.801~3.214;OR=2.494,95%CI 1.407~3.971;OR=1.868,95%CI 1.571~2.142)(P<0.05或P<0.01)。校正混杂因素Logistic回归模型多因素分析结果显示,高HGI水平是DCAN发病的独立危险因素(P<0.01)。结论DCAN发病与HGI、糖尿病家族史、FPG、HbA_(1c)、hs-CRP及UACR水平密切相关,且高HGI水平是DCAN发病的独立危险因素。

Objective To investigate the risk factors of diabetic cardiac autonomic neuropathy(DCAN)and its relationship with hemoglobin glycation index(HGI).Methods The clinical data of 497 patients with type 2 diabetes admitted to Anqing First People′s Hospital of Anhui Medical University from Jan.2017 to Jan.2021 were retrospectively analyzed.According to the occurrence of DCAN,they were divided into a DCAN group(147 cases)and a non-DCAN group(350 cases),and the general data and laboratory examination indexes of the two groups were compared.The independent risk factors for DCAN were evaluated by Logistic regression model.Results Age,family history of diabetes,dyslipidemia,fasting blood glucose(FPG),glycosylated hemoglobin(HbA_(1c)),high-sensitivity C-reactive protein(hs-CRP),urinary albumin/creatinine ratio(UACR),and HGI levels in the DCAN group were significantly higher than those in the non-DCAN group(P<0.05 or P<0.01).The triglyceride(TG),difference between the maximum heart rate in deep expiration and the minimum heart rate in deep inspiration and the ratio of R-R in Wallis test were lower than those in the non-DCAN group(P<0.01).Multivariate Logistic regression analysis showed that HGI,family history of diabetes,FPG,HbA_(1c),hs-CRP,UACR and dyslipidemia were all independent influencing factors for DCAN(OR=2.061,95%CI 1.833-2.865;OR=1.719,95%CI 1.501-1.949;OR=1.543,95%CI 1.013-2.106;OR=2.042,95%CI 1.545-2.931;OR=2.305,95%CI 1.801-3.214;OR=2.494,95%CI 1.407-3.971;OR=1.868,95%CI 1.571-2.142)(P<0.05 or P<0.01).Multivariate analysis results of adjusted confounding Logistic regression model showed that high HGI level was an independent risk factor for DCAN(P<0.01).Conclusion The onset of DCAN is closely related to HGI level,family history of diabetes,FPG level,HbA_(1c)level,hs-CRP level and UACR level,and high HGI level is an independent risk factor for the onset of DCAN.