2型糖尿病血糖、糖化血红蛋白与静息心率的相关性研究
摘要
目的探讨2型糖尿病(T2DM)患者空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)与静息心率(RHR)是否存在着某种关系,为降低主要心血管不良事件(MACE)的发生提供临床依据。方法选择2015年3月至2017年12月在该院住院的T2DM患者1 379例,根据RHR进行分组,分析年龄、性别、吸烟、高血压、冠心病、T2DM病程、FPG、2hPG和HbA1c等临床资料。结果RHR>80次/分组T2DM患者糖尿病病程[(8.93±3.62)年比(6.41±2.73)年,P=0.015]及冠心病(25.30%比14.42%,P=0.000)均高于RHR≤80次/分组患者,差异均有统计学意义(P<0.01);随着T2DM病程延长冠心病发病率呈增高趋势,1～10年为11.38%,>10～20年为20.17%、>20年为34.42%,差异有统计学意义(P<0.05);随着RHR升高FPG、2hPG和HbA1c水平呈上升趋势,线性回归分析显示,RHR与FPG(r=0.559,P<0.01)、2hPG(r=0.587,P<0.01)和HbA1c(r=0.568,P<0.01)呈明显正相关性。结论 T2DM患者长期血糖、HbA1c控制不达标致心肌损伤可能是引起RHR升高的主要原因。
引文
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[2]GUARIGUATA L,WHITING D R,HAMBLETON I,et al.Global estimates of diabetes prevalence for 2013and projections for 2035[J].Diabetes Res Clin Pract,2014,103(2):137-149.
[3]JENSEN M T,MAROTT J L,ALLIN K H,et al.Resting heart rate is associated with cardiovascular and all-cause mortality after adjusting for inflammatory markers:The Copenhagen City Heart Study[J].Eur J Prev Cardiol,2012,19(1):102-108.
[4]TOMLINSON B,DALAL J J,HUANG J,et al.The role ofβ-blockers in the management of hypertension:an Asian perspective[J].Curr Med Res Opin,2011,27(5):1021-1033.
[5]胡大一.心血管疾病防治指南和共识2010[M].北京:人民卫生出版社,2010:1-18.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中国实用乡村医生杂志,2014,42(24):3-10.
[7]WANG A X,CHEN S H,WANG C X,et al.Resting heart rate and risk of cardiovascular diseases and all-cause death:the Kailuan study[J].PLoS One,2014,9(10):e110985.
[8]ZHANG D F,SHEN X L,QI X.Resting heart rate and all-cause and cardiovascular mortality in the general population:a meta-analysis[J].Can Med Assoc J,2016,188(3):E53-63.
[9]ZAFRIR B,AZENCOT M,DOBRECKY-MERY I,et al.Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes[J].Eur J Prev Cardiol,2016,23(12):1298-1306.
[10]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J/CD].中国医学前沿杂志(电子版),2015,30(3):26-89.
[11]DAVY K P,ORR J S.Sympathetic nervous system behavior in human obesity[J].Neurosci Biobehav Rev,2009,33(2):116-124.
[12]FLANAGAN D,VAILE J C,PETLEY G W,et al.The autonomic control of heart rate and insulin resistance in young adults[J].J Clin Endocrinol Metab,1999,84(4):1263-1267.
[13]BANTHIA S,BERGNER D W,CHICOS A B,et al.Detection of cardiovascular autonomic neuropathy using exercise testing in patients with type 2diabetes mellitus[J].J Diabetes Complications,2013,27(1):64-69.
[14]HILLIS G S,WOODWARD M,RODGERS A,et al.Resting heart rate and the risk of death and cardiovascular complications in patients with type 2diabetes mellitus[J].Diabetologia,2012,55(5):1283-1290.
[15]MARINI M A,SUCCURRO E,CASTALDO E,et al.Cardiometabolic risk profiles and carotid atherosclerosis in individuals with prediabetes identified by fasting glucose,postchallenge glucose,and hemoglobin a(1c)criteria[J].Diabetes Care,2012,35(5):1144-1149.
[16]SCHRAMM T K,GISLASON G H,KOBER L,et al.Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk:apopulation study of 3.3 million People[J].Circulation,2008,117(15):1945-1954.
[17]BEMELMANS R H,WASSINK A M,VAN DER GRAAFY,et al.Risk of elevated resting heart rate on the development of type 2diabetes in patients with clinically manifest vascular diseases[J].Eur J Endocrinol,2012,166(4):717-725.
[18]JE H E,BITTNER V,DEMICCO D A,et al.Usefulness of heart rate at rest as a predictor of mortality,hospitalization for heart failure,myocardial infarction,and stroke in patients with stable coronary heart disease(data from the treating to new targets[TNT]trial)[J].Am J Cardiol,2010,105(7):905-911.
[19]王娜,高玉梅,刘振东,等.老年原发性高血压患者餐后血糖水平与心率变异性的相关性研究[J].中国社区医师,2015,28(7):27-28,30.