冠心病合并糖尿病患者心脏变时功能的变化  

Cardiac chronotropic change in patients with coronary herat disease complicated with diabetes mellitus

作　　者：冯应君[1] 杨汉东[1] 闵新文[1] 李东峰[1] 王波[2] 

机构地区：[1]郧阳医学院附属东风医院心内科,十堰442008 [2]上海市中西医结合医院,200082

出　　处：《重庆医学》2008年第2期164-165,167,共3页Chongqing medicine

摘　　要：目的探讨冠心病合并糖尿病患者心脏变时功能的变化。方法选择经冠状动脉造影确诊的30例冠心病合并糖尿病患者和35例冠心病不合并糖尿病患者,所有患者完成24h动态心电图检查并求心率变异时域指标,完成症状限制性踏车运动试验并求心脏变时功能指标最高心率与预测最大心率值之比(rHR)和心率储备率(HRR)。结果冠心病合并糖尿病患者各项心率变异指标和变时功能指标显著低于冠心病不合并糖尿病患者(P<0.05)。所有病例的心率变异指标SDNN、SDANN、SDN-Nindex、rMSSD与rHR(依次r=0.502、0.438、0.369、0.327,均P<0.01)和HRR(依次r=0.544、0.492、0.407、0.312,均P<0.05)均呈正相关。结论冠心病合并糖尿病患者心脏变时功能和心率变异性比冠心病患者更低,冠心病合并糖尿病患者心脏变时功能降低与心脏自主神经功能失常相关。Objective To explore the change of cardiac chronotropic function in the patients with coronary herat disease（CHD） complicated with diabetes mellitus（DM）. Methods Thirty patients with CHD complicated with DM and 35 patients with CHD without diabetes were selected. 24h dynamic electrocardiogram were accomplished and time domain indexes of heart rate variability （HRV） were measured for every patient. Meanwhile, symptom-limited exercise treadmill tests was executed, the chronotropic action was measured and expressed as ratio of heart rate reserve（HRR） and the percent maximal age-predicted heart rate achieved （rHR）. Results In the patients with CHD complicated with DM,all HRV indexes and cardiac chronotropic indexes were lower than those in the patients with CHD （P〈0. 05）. There were significantly positive correlation relationship between HRV indexes SDNN, SDANN,SDNNindex,rMSSD and rHR（r=0. 502,0. 438,0. 369,0. 327,respectively. all P（0.05） ,HRR（r=0. 544,0. 492,0. 407, 0. 312,respectively. all P〈0.05）. Conclusion In the patients with CHD complicated with DM, HRV and cardiac chronotropic function are lower than those in the patients with CHD. There is very intimate correlation between chronotropic incompetence and cardiac dysautonomia in CHD patients with DM. The possible mechanisms may be that vagal activity is not inhibited sufficiently and sympathetic activity is not augmentated equately in exercise tests. It is supposeed that cardiac chronotropic could reflect activity of autonomic nerve.

关 键 词：糖尿病 冠状动脉性心脏病 变时功能不全 自主神经 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]