糖尿病患者心脏自主神经病变的电生理评估  

Electric physiological evaluation for cardiovascular autonomic neuropathy in diabetic patients

作　　者：袁凤山[1] 赵锦[2] 张锦[1] 胡凤楠[1] 

机构地区：[1]中国医科大学附属第一医院内分泌科,辽宁省沈阳市110001 [2]锦州市中心医院内分泌科,辽宁省锦州市121004

出　　处：《中国临床康复》2004年第24期5034-5036,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的观测心率变异性(heartratevariability,HRV)各频谱参数在糖尿病心脏自主神经病变(cardiovascularautonomicneuropathy,CAN)各阶段的改变,探索糖尿病CAN的早期诊断方法,为有效防止糖尿病CAN的发生、发展提供监测手段。方法根据传统心脏自主神经功能检查将104例糖尿病患者按CAN程度分为4组单纯糖尿病组10例(男8例,女2例),早期CAN组30例(男13例,女17例),肯定CAN组24例(男10例,女14例),严重CAN组40例(男13例,女27例)。每例均检测八项HRV频谱参数,同时检查眼底、尿蛋白、周围神经传导速度及心电图。分析HRV各频谱参数在糖尿病各组间的差异及与正常人群间的差异。结果心率变异性各频谱参数在糖尿病早期CAN组已显著下降,且早于视网膜病变及肌电图改变,与CAN严重程度的相关系数分别为高频-0.43,低频-0.40,总功率-0.38,R-R间隔的方差(varianceofR-Rinterval,Var)-0.35,极低频-0.34,低频百分率-0.32,P均<0.01。极低频、高频、总功率、Var与乏氏指数、深呼吸心率差、卧立位30/15比值显著相关(r=0.30～0.46,P<0.01),低频与乏氏指数、深呼吸心率差、卧立位30/15比值、卧立位血压差、握拳实验显著相关(r=0.20～0.44,P均<0.01)。低频百分率与乏氏指数、卧立位血压差、握拳实验相关(r=0.21～0.30,P<0.05)。AIM:To observe the alteration of the frequency domain parameters of heart rate variability(HRV) in different stages of diabetic cardiovascular autonomic neuropathy(CAN),so as to explore the earlier diagnostic methods of diabetic CAN,and offer the monitorial means for the valid prevention of diabetic CAN.METHODS:Totally 104 patients with diabetes mellitus(DM) were divided into four groups according to the degree of diabetic CAN by means of traditional cardiovascular autonomic nervous check up:simple DM group(n=10,8 males and 2 females),early CAN group(n=30,13 males and 17 females),affirmative CAN group(n=24,10 males and 14 females) and serious CAN group(n=40,13 males and 27 females).Every patient was examined with eight frequency domain parameters of the HRV,and eyeground,albuminuria,peripheral nervous conductive velocity(PNCV) and electrocardiograph(ECG) were checked at the same time.The differences in each frequency domain parameter of HRV among the groups and between the normal group and other groups were analyzed.RESULTS:Every frequency domain parameter of HRV was significantly decreased in the early CAN group and the changes were earlier than the retinopathy and electromyograms,and the related coefficients of the parameters with the degree of CAN were-0.43 for high frequency,-0.40 for low frequency,-0.38 for total power,-0.35 for variance of R-R interval(Var),-0.34 for very low frequency and-0.32 for low frequency percentage(P< 0.01).Very low frequency,low frequency,high frequency,total power and Var were markedly correlated with valsava ratio,deep respiration test and uprighting 30/15 ratio(r=0.30-0.46,P< 0.01),besides,low frequency was correlation with postural fall in blood pressure and sustained handgrip test also(r=0.20-0.44,P< 0.01).Low frequency percentage was correlation mainly with postural fall in blood pressure,sustained handgrip test and valsava ratio(r=0.21-0.30,P< 0.05).CONCLUSION:The frequency domain examination of HRV takes on strong specificity to diabetic CAN.The changes of the measured para

关 键 词：糖尿病 心脏自主神经病变 电生理评估 心率变异性 早期诊断 

分 类 号：R587.2[医药卫生—内分泌] R541[医药卫生—内科学]