2型糖尿病患者胰岛β细胞功能与心率变异性的关联研究  

Association between isletβcell function and heart rate variability in patients with type 2 diabetes mellitus

作　　者：李明杰 康建华 林宁[1] 金杰[1] 简蔚霞[1] 苏青[1] LI Mingjie;KANG Jianhua;LIN Ning;JIN Jie;JIAN Weixia;SU Qing(Department of Endocrinology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院内分泌科,上海200092

出　　处：《内科理论与实践》2020年第2期99-104,共6页Journal of Internal Medicine Concepts & Practice

基　　金：国家自然科学基金项目(项目编号:81670746)。

摘　　要：目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者胰岛β细胞功能与心率变异性(heart rate variability,HRV)指标之间的相关性,探讨T2DM患者胰岛β细胞功能与心脏自主神经病变的关系。方法:连续收集住院T2DM患者183例,所有患者入院均行24 h动态心电图(Holter)检测HRV,在排除潜在的影响因素后纳入研究对象153例。收集所有研究对象的一般病史资料、人体测量学指标和临床生化检测结果。根据前期统计结果,按照餐后2 h C肽(2 hours C-peptide,C2)与空腹C肽(fasting C-peptide,C0)比值(C2/C0)分为低比值组和高比值组,采用独立样本t检验、非参数检验分析比较C2/C0高比值组与低比值组间各指标的差异,采用Spearman相关性分析探讨C2/C0与HRV指标之间的相关性,采用Logistic回归模型分析HRV相关指标下降的危险因素。结果:T2DM患者中C2/C0低比值组正常RR间期标准差(standard diviation of normal to normal intervals,SDNN)与5 min平均SDNN(standard diviation of the 5-minute average of normal to normal intervals,SDANN)显著低于高比值组,SDNN与SDANN和C2/C0呈正相关(分别为r=0.230、0.185,均P<0.05),高C2/C0水平是HRV下降[SDNN和(或)SDANN降低]的保护因素[优势比(odds ratio,OR)=0.660,95%可信区间(confidence interval,CI):0.442~0.986,P<0.05]。结论:在T2DM患者中,低C2/C0水平是HRV相关指标降低的危险因素,提示胰岛β细胞分泌功能可能用于预测HRV指标的改变,有望成为心脏自主神经病变的有效预测因子。Objective To explore the correlation between the isletβcell function and heart rate variability(HRV)parameters in the type 2 diabetes mellitus(T2 DM)patients,and probe the relationship between the isletβcell function and cardiac autonomic neuropathy.Methods A total of 183 hospitalized T2 DM patients were consecutively screened and had24-hour Holter to monitor HRV.After excluding potential influencing factors,153 subjects were enrolled in the study.Data on general medical history,anthropometric measures,clinical biochemical tests were collected.Patients were divided into lower 2 h C-peptide(C2)/fasting C-peptide(C0)group and higher C2/C0 group according to C2/C0 ratio.Independent sample t test and nonparametric test were conducted to compare the differences between the two groups.Spearman’s correlation was adopted to explore the relationship between C2/C0 and HRV parameters.Logistic regression was performed to establish the risk factors for the reduction of HRV.Results Standard deviation of normal to normal intervals(SDNN)and standard deviation of the 5-minute average of normal to normal intervals(SDANN)were significantly lower in the lower C2/C0 group compared with the higher C2/C0 group,and there were positive correlations between SDNN,SDANN and C2/C0 in T=2 DM patients(r=0.230,0.185,respectively,both P<0.05).Higher C2/C0 was the independent protective factor for reduction of HRV[reduction of SDNN and(or)SDANN][odds ratio(OR)=0.660,95%confidence interval(CI)=0.442~0.986,P<0.05].Conclusions In T2 DM patients,lower C2/C0 is the risk factor for the reduction of HRV,suggesting that variation of the secretion function of isletβcells may predict the changes of HRV parameters and indicate presence of cardiac autonomic neuropathy.

关 键 词：2型糖尿病 C肽 心率变异性 Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]