HGI联合基于Ewing的HRV诊断预测T2DM患者心脏自主神经病变的价值  

Value of HGI combined with Ewing based HRV diagnostic combination in predicting cardiac autonomic neuropathy in T2DM patients

作　　者：上官同琴 Shangguan Tongqin(Zhengzhou Ninth People’s Hospital,Department of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]郑州市第九人民医院中医科,河南郑州450000

出　　处：《中国实验诊断学》2023年第11期1264-1268,共5页Chinese Journal of Laboratory Diagnosis

基　　金：国家重点研发计划重大慢性病非传染性疾病防控研究重点专项(项目编号:2017YFC1310700)

摘　　要：目的探讨糖化血红蛋白变异指数(HGI)联合基于Ewing的心率变异性(HRV)诊断预测2型糖尿病(T2DM)患者心脏自主神经病变(DCAN)的价值。方法选取2020年1月至2022年2月在郑州市第九人民医院治疗的T2DM患者140例。以Ewing试验为诊断金标准,分析DCAN和非DCAN患者临床资料、Ewing-HRV诊断参数差异,同时分析发生DCAN的影响因素。结果DCAN发生率为47.14%。DCAN患者糖尿病病程、空腹血糖、糖化血红蛋白(HbA1c)和胰岛素抵抗指数(HOMA-IR)分别为(5.40±1.02)年、(12.01±1.18)mmol/L、(11.43±1.82)%和(6.20±1.02)显著高于非DCAN患者(P<0.05)。HGI为(-0.44±0.19)显著低于非DCAN患者(P<0.05)。伴有DCAN、伴有微血管病变和DCAN患者HGI明显低于单纯T2DM、伴有微血管病变患者(P<0.05);伴有微血管病变患者HGI明显低于单纯T2DM患者(P<0.05)。DCAN患者握力试验时高频功率(HF)、静息状态时LF/HF、Valsalva动作时低频功率(LF)分别为(119.20±12.01)ms^(2)、(3.12±0.83)和(210.10±22.43)ms^(2),显著低于非DCAN患者(P<0.05)。空腹血糖、HbA1c、HOMA-IR、HGI、握力试验时HF、静息状态时LF/HF、Valsalva动作时LF是患者发生DCAN的影响因素(P<0.05)。HGI预测DCAN的ROC曲线下面积为0.882(P<0.05)。HGI联合Ewing-HRV诊断预测DCAN的灵敏性和阴性预测值分别为96.97%和96.92%,明显高于单独应用Ewing-HRV诊断(P<0.05)。结论HGI联合Ewing-HRV诊断预测T2DM患者DCAN有一定应用价值,值得临床使用。Objective To explore the value of HGI combined with Ewing-based HRV diagnostic combination in predicting DCAN in T2DM patients.Methods A total of 140 T2DM patients treated in our hospital from January 2020 to February 2022 were selected.Using the Ewing test as the diagnostic gold standard,the clinical data and Ewing-HRV diagnostic combination parameters of DCAN and non-DCAN patients were analyzed,and the influencing factors of DCAN were also analyzed.Results The incidence of DCAN was 47.14%.The duration of diabetes,fasting blood glucose,glycated hemoglobin(HbA1c)and insulin resistance index(HOMA-IR)in DCAN patients were(5.40±1.02)years,(12.01±1.18)mmol/L,(11.43±1.82)%and(6.20±1.02),respectively.1.02 was significantly higher than that of non-DCAN patients(P<0.05).HGI was(-0.44±0.19)significantly lower than that of non-DCAN patients(P<0.05).HGI in patients with DCAN,microvascular lesions and DCAN was significantly lower than that in patients with T2DM and microvascular lesions,(P<0.05);HGI in patients with microvascular lesions was significantly lower than that in patients with T2DM,(P<0.05).The high-frequency power(HF)in the grip strength test of DCAN patients,the LF/HF in the resting state,and the low-frequency power(LF)in the Valsalva action were(119.20±12.01)ms^(2),(3.12±0.83)and(210.10±22.43)ms^(2),respectively.lower than that of non-DCAN patients(P<0.05).Fasting blood glucose,HbA1c,HOMA-IR,HGI,HF during grip strength test,LF/HF during resting state,and LF during Valsalva movement were the influencing factors of DCAN(P<0.05).The area under the ROC curve of HGI predicted DCAN was 0.882,(P<0.05).The sensitivity and negative predictive value of HGI combined with Ewing-HRV diagnostic combination in predicting DCAN were 96.97%and 96.92%,which were significantly higher than those of Ewing-HRV diagnostic combination alone(P<0.05).Conclusion HGI combined with Ewing-HRV diagnostic combination has a certain application value in predicting DCAN in T2DM patients and is worthy of clinical use.

关 键 词：糖化血红蛋白变异指数 Ewing试验 心率变异性 2型糖尿病 心脏自主神经病变 

分 类 号：R587.1[医药卫生—内分泌]