2型糖尿病患者心脏自主神经病变相关危险因素  

Risk Factors Related to Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus

作　　者：徐梦珠 吴坚 郝娟 沈晓喻 XU Mengzhu;WU Jian;HAO Juan;SHEN Xiaoyu(Shanghai University of Traditional Chinese Medicine,Shanghai 200082,China;Department of Endocrinology,Shanghai TCM-Integrated Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200082,China)

机构地区：[1]上海中医药大学,上海200082 [2]上海中医药大学附属上海市中西医结合医院内分泌科,上海200082

出　　处：《医学综述》2022年第2期372-379,共8页Medical Recapitulate

基　　金：国家自然科学基金(81803874);上海市卫生健康委员会科研课题(202040406);上海市虹口区卫生健康委员会中医药科研课题(HKQ-ZYY-2020)。

摘　　要：目的分析2型糖尿病(T2DM)患者心脏自主神经病变的相关危险因素。方法采取随机抽样法选择2020年2—12月于上海中医药大学附属上海市中西医结合医院内分泌科住院的154例T2DM患者作为研究对象,患者均接受心血管反射试验,以心血管反射试验为诊断糖尿病心脏自主神经病变(DCAN)的金标准,分为DCAN组和无DCAN组,同时记录患者一般资料及生化指标等,分析DCAN的相关危险因素及对DCAN发生发展的预测价值。结果154例T2DM患者中,DCAN患者101例,无DCAN患者53例,DCAN发生率为65.6%(101/154)。两组间年龄、糖尿病病程比较差异有统计学意义(P<0.01),DCAN组糖尿病周围神经病变比例、胱抑素C(CysC)水平高于无DCAN组[75.25%(76/101)比56.60%(30/53),0.87(0.78,0.99)mg/L比0.79(0.73,0.92)mg/L](χ^(2)=5.632,P=0.018;Z=2.808,P=0.005),空腹C肽(FCP)低于无DCAN组[(1.86±0.95)μg/L比(2.34±1.12)μg/L](t=2.817,P=0.005)。两组性别、高血压比例、体质指数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、肿瘤坏死因子-α、神经元特异性烯醇化酶、同型半胱氨酸(Hcy)、糖化血红蛋白、血肌酐、尿酸、空腹血糖、餐后2 h血糖(2 h PG)比较差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:Hcy、2 h PG、FCP均为DCAN的独立影响因素(OR=1.272,95%CI 1.078~1.501;OR=1.098,95%CI 1.003~1.201;OR=0.528,95%CI 0.335~0.832,P<0.05或P<0.01)。受试者工作特征曲线分析显示,Hcy、2 h PG、FCP的曲线下面积分别为0.574、0.564、0.627。结论Hcy、2 h PG、FCP均为DCAN的独立影响因素,三者AUC面积均处于0.5~0.7,对诊断DCAN具有一定预测价值。Objective To analyze the related risk factors of cardiac autonomic neuropathy in patients with type 2 diabetic mellitus(T2DM).Methods A total of 154 hospitalized T2DM patients in Department of Endocrinology,Shanghai TCM-Integrated Hospital,Shanghai University of Traditional Chinese Medicine from Feb.to Dec.2020 were selected by random sampling method.All the patients underwent standard cardiovascular reflex test.With cardiovascular reflex test as the gold standard for diagnosing diabetic cardiovascular autonomic neuropathy(DCAN),the patients were divided into a DCAN group and a non-DCAN group.At the same time,general patient data and biochemical indicators were recorded,and the related risk factors of DCAN and their predictive value for DCAN occurrence were analyzed.Results Among the 154 T2DM patients,101 were DCAN patients and 53 were non-DCAN patients,with the incidence of DCAN being 65.6%(101/154).There were statistically significant differences in age and course of disease between the two groups(P<0.01).The proportion of diabetic peripheral neuropathy and cystatin C(CysC)in group DCAN were higher than those in group DCAN[75.25%(76/101)vs 56.60%(30/53),0.87(0.78,0.99)mg/L vs 0.79(0.73,0.92)mg/L](χ^(2)=5.632,P=0.018;Z=2.808,P=0.005),fasting C-peptide(FCP)was lower than that without DCAN[(1.86±0.95)μg/L vs(2.34±1.12)μg/L](t=2.817,P=0.005).There were no significant differences in gender,proportion of hypertension,body mass index,total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,tumor necrosis factor-α,neuron-specific enolase,homocysteine(Hcy),glycated hemoglobin,serum creatinine,uric acid,fasting blood glucose,2 h postprandial blood glucose(2 h PG)between the two groups(P>0.05).The mul-tivariate Logistic regression analysis showed that Hcy,2 h PG,and FCP were all independent influencing factors of DCAN(OR=1.272,95%CI 1.078-1.501;OR=1.098,95%CI 1.003-1.201;OR=0.528,95%CI 0.335-0.832,P<0.05 or P<0.01).Receiver operating characteristic curve analysis showed

关 键 词：2型糖尿病 糖尿病心脏自主神经病变 心血管反射试验 危险因素 

分 类 号：R587.2[医药卫生—内分泌] R781.64[医药卫生—内科学]