2型糖尿病患者心率变异性降低的影响因素

Influencing factors of decreased heart rate variability in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者心率变异性(heart rate variability,HRV)降低的影响因素。方法选取71例T2DM住院患者为研究对象,根据HRV是否降低,将T2DM患者分为HRV正常组(39例)和HRV降低组(32例)。收集两组患者的一般资料、随机血糖、糖化血红蛋白(HbA1c)、甘油三酯、胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肌酐、尿酸、β2微球蛋白、尿素、HRV等各项指标。采用多因素Logistic回归分析,研究T2DM患者HRV降低的影响因素。结果与HRV正常组相比,HRV降低组患者的病程更长,其随机血糖、HbA1c、收缩压、胆固醇和LDL-C水平较高,且患冠心病、糖尿病肾病的比例及左心室舒张功能降低、ST-T改变、尿糖阳性的比例也更高,差异均有统计学意义(均P<0.05);HRV降低组患者的SDNN、SDANN、rMSSD、pNN50、HRV-index、LF和HF数值更低,且差异有统计学意义(均P<0.01)。T2DM患者的病程、随机血糖、HbA1c、冠心病是HRV降低的独立影响因素(P<0.05)。结论及时监测和控制T2DM患者HRV降低的影响因素,有利于改善其心脏自主神经功能,对改善预后也有积极意义。

Objective To investigate the factors influencing the decrease of heart rate variability(HRV)in patients with type 2 diabetes mellitus(T2DM).Methods Seventy-one inpatients with T2DM were selected as research subjects.According to whether HRV was reduced,these T2DM patients were divided into HRV normal group(39 cases)and HRV reduction group(32 cases).The general data,random blood glucose,HbA1c,triglycerides,cholesterol,LDL-C,HDL-C,creatinine,uric acid,beta-2 microglobulin,urea,and HRV indexes of the two groups were collected.Multivariate Logistic regression analysis was used to study the influencing factors of HRV reduction in T2DM patients.Results Compared with the HRV normal group,the patients in the HRV reduction group had longer course of disease,higher levels of random blood glucose,HbA1c,systolic blood pressure,cholesterol and LDL-C,and higher proportions of coronary heart disease,diabetic nephropathy,decreased left ventricular diastolic function,ST-T changes and positive urine glucose as well,all with statistically significant differences(all P<0.05).The values of SDNN,SDANN,rMSSD,pNN50,HRV-index,LF and HF in the HRV reduction group were lower than those in the HRV normal group,and the differences were all statistically significant(all P<0.01).The course of disease,random blood glucose,HbA1c,and coronary heart disease in T2DM patients were independent influencing factors for HRV reduction(P<0.05).Conclusion Timely monitoring and control of the influencing factors for HRV reduction in T2DM patients is conducive to improving the cardiac autonomic function and also has positive significance for improving their prognosis.