糖尿病足溃疡患者心率变异特点及其临床相关性研究  

Characteristics and clinical interrelation of heart rate variability in patients with diabetic foot ulcers

作　　者：顾俊义[1] 郭凯[1] 许蕾[2] 何泱[2] 施建元[1] 顾雪明[1] 汤正义[1] 宁光[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院远洋分院内科,200031 [2]上海交通大学医学院附属瑞金医院内分泌代谢病科上海市内分泌代谢病临床医学中心糖尿病足分中心上海市内分泌代谢病研究所

出　　处：《中华糖尿病杂志》2016年第2期97-102,共6页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的检测住院糖尿病足溃疡（DFU）患者的心率变异性（HRv），观察其心血管自主神经病变（CAN）发病特点及其临床相关性。方法选取2011年1月至2013年12月来我院就诊的115例DFU患者，其中男性59例，女性56例，平均年龄为（68±13）岁；另选取109例高危足（Wagner0级）患者作为对照组，其中男性74例，女性35例，平均年龄为（65±14）岁，分析比较两组间HRV各项指标的变化情况，并对DFU患者按Wagner分级进行亚组分析，比较各级别组间的变化情况；以正常R-R间期标准差（SDNN）〈70ms认为HRV异常，对DFU患者分为两组，分析HRV正常与异常组间各临床指标的差异；比较住院死亡患者中的HRV参数，并对HRV各参数进行多元回归分析。两组间均数比较采用独立样本t检验，多组均数比较采用方差分析。结果DFU患者中存在着不同程度的CAN，其中HRV异常患者占总数的51．3％，且HRV异常组周围神经病变和周围血管病变的发病率显著升高，分别由42．9％升至62．7％和30．4％升至61．0％，差异有统计学意义（X^2=4．547、10．869，P〈0．05），并且异常组中左室射血分数较正常组下降，差异有统计学意义（62±6比65±7，t=2．21，P〈0．05）。随着Wagner级别的增加，DFU组HRV分析参数中的24h平均心率显著增快（F=2．750，P〈0．05），SDNN、极低频（VLF）、低频与高频比值（LF／HF）,显著下降（F=2．275、4．349、3．084，P〈0．05），特别是死亡患者中反映交感神经张力的VLF指标显著降低（t=1．973，P〈0．05）。多元回归分析提示SDNN与糖化血红蛋白、24h尿微量白蛋白呈负相关（β=0．208、-0．214，P〈0．05），VLF与糖化血红蛋白呈负相关（β=-0．213，P〈0．05）。结论DFU患者大多数情况下合并CAN，血糖控制不佳可能是造成糖尿病CAN的重要因素之一。因此在综合治疗的同时，保持一个合理的血糖�Objective Heart rate variability（HRV） was examined in hospitalized patients with diabetic foot ulcers（DFU） to investigate the characteristics and clinical interrelation of cardiovascular autonomic neuropathy（CAN）. Methods A total of 115 patients with DFU treated in our hospital from January 2011 to December 2013 were included, and there were 59 males and 56 females with an average age of （68 ± 13） years. Another 109 individuals with high risk of DFU（Wagner 0 stage） were selected as the control group, and there were 74 males and 35 females with an average age of （65± 14） years. HRV changes were analyzed in two groups, while subgroup analysis was done in DFU group according to Wagner classification. Furthermore, the patients with DFU were divided into two groups according to standard deviation of normal number of intervals（SDNN）： patients with SDNN less than 70 ms were considered as HRV abnormal ones. Clinical indexes were compared among HRV abnormal and normal groups. The HRV parameters were tested in patients died in hospital and multi-regression model was used to analyze the association between clinical indexes and HRV parameters. The independence sample t test was implied in data comparison between two groups and variance analysis was used in data comparison among groups. Results The CAN of various degree existed in patients with DFU. Patients with abnormal HRV accounted for 51.3% of all the patients. Compared with those in controls, the incidence of peripheral neuropathy and peripheral vascular disease were significantly higher in the HRV abnormal group, which increased from 42.9% to 62.7% and 30.4% to 61.0%, respectively（X^2-4.547, 10.869, both P〈0.05）. Meanwhile, left ventricle ejection fraction was obviously decreased in the HRV abnormal group（61.9±6.5 vs 64.8±7.2, t= 2. 21, P〈0.05）. As the stage of Wagner elevated, the average heart rate increased in the DFU group（F=2.750, P〈0.05）, while SDNN, very low frequency （VLF） and low frequency to high frequen

关 键 词：糖尿病足溃疡 心血管自主神经病变 心率变异性 

分 类 号：R587.2[医药卫生—内分泌]