糖尿病心脏植物神经病变与Q-Tc间期延长的关系及其临床意义

RELATIONSHIP BETWEEN DIABETIC CARDIAC AUTONOMIC DISTURBANCES AND Q-Tc INTERVAL PROLONGATION AND ITS CLINICAL SIGNIFICANCE

对61例糖尿病作心血管植物神经功能试验与心电图Q-Tc间期测定。结果表明伴心脏植物神经功能异常者,卧、坐、立位时的Q-Tc间期均较功能正常的患者及健康对照者明显延长。若以Q-Tc间期>440ms为延长,则乏氏动作时,心血管植物神经功能重度异常组的阳性率(57％)为功能正常组(26％)及轻度异常组(25％)的2倍多;乏氏动作后重度异常组的阳性率为43％。活动使迷走-交感神经对心肌产生不均衡的影响,导致复极异常。不同体位和乏氏动作前后的Q-Tc间期,可作为预测糖尿病高危患者的指标。

Autonomic cardiovascular function tests and electrocardiograms were performed in 61 patients with diabetes mel-litus. The result showed that Q-Tc interval in diabetic patients with abnormal autonomic function was longer than both the controls and the patients with normal autonomic function at lying, sitting and standing positions. A Q-Tc interval exceeding 440 ms was considered to be prolonged. The incidence of Q-Tc interval prolongation in patients with markedly abnormal autonomic function was 57% during Valsalva maneuver, being two times higher than in patients with normal autonomic function (26%) or slightly abnormal function (25%). After Valsalva maneuver, the incidence of Q-Tc interval prolongation was 43% in the patients with markedly abnormal autonomic function. This suggests that vagal-sympathetic imbalance acting on the myocardium may result in abnormal repolarization. We propose that measuring Q-Tc interval at various postures as well as during and after Valsalva maneuver may help predicting the index of risk in diabetic patients.