上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (6): 629-.doi: 10.3969/j.issn.1674-8115.2019.06.011

• 论著·临床研究 • 上一篇    下一篇

2型糖尿病患者心率变异性降低的危险因素分析

高玮 1，王雪姣 2，甄琴 2，丁晓颖 2，徐浣白 2，王育璠 2，彭永德 2   

  1. 1. 上海交通大学附属第一人民医院医务二处，上海 200080；2. 上海交通大学附属第一人民医院内分泌代谢科，上海 200080
  • 出版日期:2019-06-28 发布日期:2019-07-26
  • 通讯作者: 丁晓颖，电子信箱：xiaoyingding@126.com。
  • 作者简介:高玮（1973—），女，副主任医师，博士；电子信箱： gaowei1108@hotmail.com。
  • 基金资助:
    国家自然科学基金（81870594）；上海申康医院发展中心临床科技创新项目（SHDC12015304，16CR4025A）；上海交通大学医学院多中心临床研究项目（DLY201824）

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

GAO Wei1, WANG Xue-jiao2, ZHEN Qin2, DING Xiao-ying2, XU Huan-bai2, WANG Yu-fan2, PENG Yong-de2   

  1. 1. Medical Affairs Department Ⅱ, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China; 2. Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
  • Online:2019-06-28 Published:2019-07-26
  • Supported by:
    National Natural Science Foundation of China, 81870594; Clinical Science and Technology Innovation Project of Shanghai Hospital Development Center, SHDC12015304, 16CR4025A; Multi-center Clinical Research Project of Shanghai Jiao Tong University School of Medicine, DLY201824）。

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摘要： 目的 ·探讨 2型糖尿病患者心率变异性（heart rate variability，HRV）降低的相关危险因素。方法 ·选取上海交通大学附属第一人民医院 2013年 1月—2014年 12月收治的 210例 2型糖尿病患者，分别依据尿白蛋白肌酐比（urinary albumin creatinine ratio，UACR）、血清三酰甘油（triacylglycerol，TAG）水平和是否合并高血压进行分组。通过比较组间病例临床特征和 HRV等指标的差异，探讨 HRV指标及其影响因素间的相关关系。结果 · UACR升高组较 UACR正常组 24 h平均心率升高， SDNN［正常窦性心搏 RR间期（NN间期）标准差］降低（均 P<0.05）；TAG升高组较 TAG正常组 24 h平均心率升高， SDNN和 pNN50（相邻 NN间期差值超过 50 ms的心搏数占总心搏数的百分比）降低（均 P<0.05）；合并高血压组较对照组最小频域功率小时降低（P<0.05）。回归分析显示， TAG和 SDNN线性相关（P<0.05），舒张压和 24 h平均心率、 SDNN、频域功率 24 h、最小频域功率小时线性相关（均 P<0.05），年龄和 24 h平均心率、 SDNN、SDANN（每 5 min NN间期平均值的标准差）、频域功率 24 h、最小频域功率小时、最大频域功率小时线性相关（均 P<0.05）。结论 ·年龄、血清 TAG水平和是否合并高血压是 2型糖尿病患者 HRV降低的危险因素，早期对 HRV的降低进行检测将有助于预防糖尿病心血管事件的发生。

关键词: 2型糖尿病, 心率变异性, 尿白蛋白排泄率, 三酰甘油, 高血压

Abstract:

Objective · To analyze the related risk factors of decreased heart rate variability (HRV) in type 2 diabetes mellitus (T2DM) patients. Methods · A total of 210 cases with T2DM in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine Jan. 2013 to Dec. 2014 were divided into two groupsthe levels of urinary albumin creatinine ratio (UACR) and serum triacylglycerol (TAG), and with/without hypertension, respectively.comparing the differences of clinical characteristics, HRV parameters and other general clinical data between the two groups, the correlations between HRV indexes and their risk factors were explored. Results · The average heart rate of the whole day was higher, and SDNN [normal RR intervals of sinus beats (NN intervals) standard deviation]was lower in the high UACR group than those in the normal UACR group (both P<0.05). The average heart rate of the whole day was higher, while SDNN and pNN50 (percentage of total heart beats with adjacent NN intervals greater than 50 ms) were lower in the hypertriglyceridemia group than those in the normal TAG group (all P<0.05). Minimum frequency domain power hour was lower in the hypertension group than that in the normotension group (P<0.05). Regression analysis showed that the linear correlativity between TAG and SDNN was very prominent (P<0.05), as well as between the diastolic blood pressure (DBP) and the average heart rate of the whole day, SDNN, frequency domain power 24 hours and minimum frequency domain power hour (all P<0.05). Similarly, the age was linearly correlated significantly with the average heart rate of the whole day, SDNN, SDANN (the standard deviation of the mean NN intervals every 5 min), frequency domain power 24 hours, minimum frequency domain power hour and maximum frequency domain power hour (all P<0.05). Conclusion · Age, TAG level and hypertension are the risk factors of decreased HRV in T2DM patients. Thus, early detection of the decrease of HRV in these patients can prevent the cardiovascular events of T2DM.

Key words: type 2 diabetes mellitus (T2DM), heart rate variability (HRV), urinary albumin excretion, triacylglycerol (TAG), hypertension

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