糖尿病患者的心率减速力和连续心率减速力研究
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摘要
目的探讨糖尿病患者心率减速力(DC)及连续心率减速力(DRs)的特点及临床意义。方法选择海南医学院第二附属医院2002-2017年门诊和住院的75例糖尿病患者为糖尿病组,80例健康者为对照组,进行24 h动态心电图监测,计算两组研究对象的DC、DRs、心率变异性(HRV)时域指标[SDNN (窦性R-R间期的标准差)、相邻R-R间期差值的均方根(RMSSD)、R-R间期差值>50 ms的连续正常的R-R间期数(PNN50)],并对DC、DRs进行危险分层(高危、中危、低危),同时将糖尿病患者分为有心血管事件组和无心血管事件组,统计糖尿病患者发生心血管事件的情况。结果糖尿病组患者的DC低危、中危、高危患者分别为54例、15例和6例,对照组分别为76例、4例和0例,两组DC危险分级比较差异均有统计学意义(P<0.05);糖尿病组患者的DC、SDNN、RMSSD、PNN50、DR2、DR4、DR8分别为(5.5±1.9) ms、(125±25.5) ms、(24.1±11.5) ms、(6.7±5.7)%、(7.21±1.02)%、(0.69±0.11%)%、(0.068±0.032)%,明显低于对照组的(6.4±2.5) ms、(138±31.5) m、(30.5±12.3) ms、(10.5±9.2)%、(8.54±2.34)%、(0.78±0.16)%、(0.084±0.026)%,差异均有统计学意义(P<0.05);糖尿病患者的DC与HRV时域指标(SDNN、rMSSD、PNN50)和DRs均呈中高度正相关(P<0.05);糖尿病组患者中有心血管事件组的DC、SDNN、RMSS、PNN50、DR2、DR4、DR8分别为(4.2±1.9) ms、(104.7±23.7) ms、(20.1±9.1) ms、(6.0±0.9)%、(6.1±1.7)%、(0.59±0.09)%、(0.059±0.013)%,明显低于无心血管事件组的(5.7±2.1) ms、(128.2±26.1) ms、(27.6±10.6) ms、(7.1±1.1)%、(7.7±1.9)%、(0.71±0.10)%、(0.072±0.021)%,差异均有统计学意义(P<0.05)。结论糖尿病患者DC、DRs降低,DC与DRs、HRV对糖尿病患者的心血管事件的发生有预测价值。
Objective To investigate the characteristics and clinical significance of heart rate deceleration force(DC) and heart rate deceleration runs(DRs) in patients with diabetes mellitus(DM). Methods Seventy-five patients with DM in the Second Affiliated Hospital of Hainan Medical University from 2002 to 2017 were selected as DM group, and eighty healthy people were enrolled as control group. 24-hour ambulatory electrocardiogram was monitored in all the patients. The DC, DRs, heart rate variability(HRV) domain indexes(standard deviation of NN intervals [SDNN],root mean square of successive differences [RMSSD], percentage of differences exceeding 50 ms between adjacent NN intervals [PNN50]) were calculated between the two groups of subjects, and the risk stratification of DC, DRs was carried out(high, moderate and low risk). At the same time, the diabetic patients were divided into cardiovascular event group and non-cardiovascular event group, and cardiovascular events were analyzed. Results The number of patients in risk stratification of DC(low, moderate and high risk groups) were 54 cases, 15 cases, 6 cases in DM group, respectively,which were significantly higher than 76 cases, 4 cases, 0 in control group(P<0.05). DC, HRV domain indexes(SDNN,RMSSD, PNN50), and DRs(DR2, DR4, DR8) of DM group were(5.5±1.9) ms,(125±25.5) ms,(24.1±11.5) ms,(6.7±5.7)%,(7.21±1.02)%,(0.69±0.11%)%,(0.068±0.032)%, respectively, which were significantly lower than(6.4±2.5) ms,(138±31.5) ms,(30.5±12.3) ms,(10.5±9.2)%,(8.54±2.34)%,(0.78±0.16)%,(0.084±0.026)% of control group(P<0.05).The DC was positively correlated with HRV indexes(SDNN, rMSSD, PNN50) and DRs in diabetic patients(P<0.05).The DC, HRV domain indexes(SDNN, RMSSD, PNN50) and DRs(DR2, DR4, DR8) in DM patients with cardiovascular events were(4.2±1.9) ms,(104.7±23.7) ms,(20.1±9.1) ms,(6.0±0.9)%,(6.1±1.7)%,(0.59±0.09)%,(0.059±0.013)%,respectively, which were significantly lower than(5.7 ± 2.1) ms,(128.2 ± 26.1) ms,(27.6 ± 10.6) ms,(7.1 ± 1.1)%,(7.7 ±1.9)%,(0.71±0.10)%,(0.072±0.021)% of DM patients without cardiovascular events(P<0.05). Conclusion DC, DRs was decreased in diabetic patients, and DC, DRs, HRV has predictive value for cardiovascular events in diabetic patients.
Objective To investigate the characteristics and clinical significance of heart rate deceleration force(DC) and heart rate deceleration runs(DRs) in patients with diabetes mellitus(DM). Methods Seventy-five patients with DM in the Second Affiliated Hospital of Hainan Medical University from 2002 to 2017 were selected as DM group, and eighty healthy people were enrolled as control group. 24-hour ambulatory electrocardiogram was monitored in all the patients. The DC, DRs, heart rate variability(HRV) domain indexes(standard deviation of NN intervals [SDNN],root mean square of successive differences [RMSSD], percentage of differences exceeding 50 ms between adjacent NN intervals [PNN50]) were calculated between the two groups of subjects, and the risk stratification of DC, DRs was carried out(high, moderate and low risk). At the same time, the diabetic patients were divided into cardiovascular event group and non-cardiovascular event group, and cardiovascular events were analyzed. Results The number of patients in risk stratification of DC(low, moderate and high risk groups) were 54 cases, 15 cases, 6 cases in DM group, respectively,which were significantly higher than 76 cases, 4 cases, 0 in control group(P<0.05). DC, HRV domain indexes(SDNN,RMSSD, PNN50), and DRs(DR2, DR4, DR8) of DM group were(5.5±1.9) ms,(125±25.5) ms,(24.1±11.5) ms,(6.7±5.7)%,(7.21±1.02)%,(0.69±0.11%)%,(0.068±0.032)%, respectively, which were significantly lower than(6.4±2.5) ms,(138±31.5) ms,(30.5±12.3) ms,(10.5±9.2)%,(8.54±2.34)%,(0.78±0.16)%,(0.084±0.026)% of control group(P<0.05).The DC was positively correlated with HRV indexes(SDNN, rMSSD, PNN50) and DRs in diabetic patients(P<0.05).The DC, HRV domain indexes(SDNN, RMSSD, PNN50) and DRs(DR2, DR4, DR8) in DM patients with cardiovascular events were(4.2±1.9) ms,(104.7±23.7) ms,(20.1±9.1) ms,(6.0±0.9)%,(6.1±1.7)%,(0.59±0.09)%,(0.059±0.013)%,respectively, which were significantly lower than(5.7 ± 2.1) ms,(128.2 ± 26.1) ms,(27.6 ± 10.6) ms,(7.1 ± 1.1)%,(7.7 ±1.9)%,(0.71±0.10)%,(0.072±0.021)% of DM patients without cardiovascular events(P<0.05). Conclusion DC, DRs was decreased in diabetic patients, and DC, DRs, HRV has predictive value for cardiovascular events in diabetic patients.
引文
[1]汤晓芙.神经病学[M].北京:人军医出版社, 2002:283-284.
[2] Davidson EP, Coppey LJ, Holmes A, et al. Effect of treatment of high fat fed/low dose stretozotocin-diabetic rats with llepatril on vascular and neural complications[J]. Eur J Pharmacol, 2011, 668(3):497-506.
[3] Negi G, Kumar A, Joshi RP, et al. Oxidative stress and Nrf2 in the pathophysiology of diabetic neuropathy:old perspective with a new angle[J]. Biochem Biophys Res Commun, 2011, 408(1):1-5.
[4]胡沛,马莉.糖尿病并发急性心肌梗死的研究进展[J].实用临床医药杂志, 2017, 21(1):205-208.
[5]薛梅.糖尿病自主神经病变对心脏电生理的影响及其干预研究[D].济南:山东大学, 2013, 2013:6-10.
[6]郭继鸿.心率减速力检测[J].临床心电学杂志, 2009, 18(1):59-68.
[7]林新海.糖尿病患者心率减速力与心率变异性分析[J].中外医学研究, 2017, 15(16):110-111.
[8]金铃胆,翁志远,徐丽娟,等.糖尿病患者心率减速力和心率变异性等指标的检测分析[J].福建医药杂志, 2015, 37(6):131-133.
[9]薛妮娜,吴岳平.糖尿病患者心率减速力与心率变异性分析[J].岭南心血管病杂志, 2012, 18(3):227-229.
[10] Vinik AI. Ziegler D. Diabetic cardiovascular autonomic neuropathy[J]. Circulation, 2007, 115(3):387-397.
[11]李路,彭瑜,张钲. TPe在急性心肌梗死中的临床意义[J].临床心血管疾病杂志, 2017, 33(5):411-415.
[2] Davidson EP, Coppey LJ, Holmes A, et al. Effect of treatment of high fat fed/low dose stretozotocin-diabetic rats with llepatril on vascular and neural complications[J]. Eur J Pharmacol, 2011, 668(3):497-506.
[3] Negi G, Kumar A, Joshi RP, et al. Oxidative stress and Nrf2 in the pathophysiology of diabetic neuropathy:old perspective with a new angle[J]. Biochem Biophys Res Commun, 2011, 408(1):1-5.
[4]胡沛,马莉.糖尿病并发急性心肌梗死的研究进展[J].实用临床医药杂志, 2017, 21(1):205-208.
[5]薛梅.糖尿病自主神经病变对心脏电生理的影响及其干预研究[D].济南:山东大学, 2013, 2013:6-10.
[6]郭继鸿.心率减速力检测[J].临床心电学杂志, 2009, 18(1):59-68.
[7]林新海.糖尿病患者心率减速力与心率变异性分析[J].中外医学研究, 2017, 15(16):110-111.
[8]金铃胆,翁志远,徐丽娟,等.糖尿病患者心率减速力和心率变异性等指标的检测分析[J].福建医药杂志, 2015, 37(6):131-133.
[9]薛妮娜,吴岳平.糖尿病患者心率减速力与心率变异性分析[J].岭南心血管病杂志, 2012, 18(3):227-229.
[10] Vinik AI. Ziegler D. Diabetic cardiovascular autonomic neuropathy[J]. Circulation, 2007, 115(3):387-397.
[11]李路,彭瑜,张钲. TPe在急性心肌梗死中的临床意义[J].临床心血管疾病杂志, 2017, 33(5):411-415.