电化学皮肤电导率对2型糖尿病心血管自主神经病变的临床价值研究

Clinical value of electrochemical skin conductance in the assessment of cardiovascular autonomic neuropathy in type 2 diabetes

目的 研究电化学皮肤电导率(ESC)与2型糖尿病心血管自主神经病变(CAN)的相关性,并探讨ESC预测CAN的适宜切点。方法 选取2022年3月至2023年7月于南京鼓楼医院集团宿迁医院内分泌科住院的2型糖尿病患者共584例,根据心血管反射实验(CARTs)分为CAN组和非CAN(NCAN)组。根据数据类型,组间比较采用独立样本t检验或Mann-Whitney U检验。采用Spearman相关性分析探讨ESC与各指标的相关性,logistic回归分析探讨CAN的影响因素,ROC曲线判定ESC对CAN的诊断价值,并寻找其预测CAN的适宜切点。结果 与NCAN组相比,CAN组的双足电化学传导率(FESC)、双手电化学传导率(HESC)更低[FESC(46.14±20.42比65.12±13.92)μS、HESC(59.42±16.63比65.14±13.34)μS,t=12.474、12.132,P<0.05)],且随CAN进展FESC、HESC进一步降低。Spearman相关性分析显示CARTs各指标与FESC、HESC呈显著正相关(r>0,P<0.01),年龄、病程及糖尿病远端对称性周围神经病变(DSPN)、糖尿病视网膜病变(DR)、糖尿病肾病(DKD)的发生与FESC、HESC均呈显著负相关(r<0,P<0.01),BUN与FESC呈负相关(r<0,P<0.05),而与HESC无相关性。logistic回归分析显示,FESC、HESC为CAN的保护因素。ROC曲线显示,FESC、HESC预测CAN的曲线下面积分别为0.780、0.772(P<0.05),阈值分别为59.5μS、56.5μS,灵敏度分别为69.6%、63.3%,特异度分别为75.2%、77.8%。结论 ESC对2型糖尿病CAN早期诊断有一定预测价值,对FESC低于59.5μS,HESC低于56.5μS的2型糖尿病患者应重视CAN的筛查及干预。

Objective To investigates the correlation of electrochemical skin conductance(ESC)with cardiovascular autonomic neuropathy(CAN)in type 2 diabetes,and explore a suitable cut-off point for ESC to predict CAN.Methods A total of 584 patients with type 2 diabetes hospitalized in the Department of Endocrinology at Nanjing Gulou Hospital Group Suqian Hospital from March 2022 to July 2023 were enrolled.Based on the results of the cardiovascular autonomic reflex test(CARTs),the patients were divided into the CAN group and the Non-CAN(NCAN)group.According to the data types,the inter-group comparison was conducted using independent samples t-test or Mann-Whitney U test.Spearman correlation analysis was used to explore the correlation between ESC and various indicators.Logistic regression analysis will be performed to identify the influencing factors of CAN.Use ROC curve to determine the diagnostic value of ESC for CAN,and look for the appropriate cut-off point for predicting CAN.ResultsCompared to the NCAN group,the CAN group showed lower Foot ESC(FESC)and Hand ESC(HESC)[FESC:(46.14±20.42vs.65.12±13.92)μS,HESC:(59.42±16.63 vs.65.14±13.34)μS,t=12.474,t=12.132,P<0.05].FESC and HESC decreased with increasing severity of CAN.Spearman correlation analysis showed that the indicators of CARTs were significantly positively correlated with FESC and HESC(r>0,P<0.01),age,course of disease,the occurrence of DSPN,DR and DKD were all significantly negatively correlated with FESC and HESC(r<0,P<0.01);BUN was negatively correlated with FESC(r<0,P<0.05),but not correlated with HESC.Logistic regression analysis revealed that FESC and HESC were protective factors for CAN.The ROC curve showed that the area under the curve for predicting CAN was 0.780 for FESC and 0.772 for HESC(P<0.05).The predictive thresholds for CAN were 59.5μS for FESC and 56.5μS for HESC,with sensitivities of 69.6%and 63.3%,respectively,and specificities of 75.2%and 77.8%,respectively.Conclusion ESC has certain predictive value in the early diagnosis of cardiovascular autonomic neuropathy(CAN),and it is important to screen and intervene for CAN in type 2 diabetes patients with FESC below 59.5μS and HESC below56.5μS.