2型糖尿病患者心脏自主神经病变危险因素研究  

Risk factors of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus

作　　者：苏冠旬 王世东[1] 李佳玥[1] 张华[1] 徐皓 李潇然 魏金艳 薛泰骑 战丽彬[4] SU Guanxun;WANG Shidong;LI Jiayue;ZHANG Hua;XU Hao;LI Xiaoran;WEI Jinyan;XUE Taiqi;ZHAN Libin(Department of Endocrinology and Nephrology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Endocrinology and Nephrology,Dongzhimen Hospital,Beijing 101121,China;Department of Endocrinology and Nephrology,Wangjing Hospital of China Academy of Chinese Medicine,Beijing 100102,China;Liaoning University Of Traditional Chinese Medicine,Shenyang,Liaoning 110032,China)

机构地区：[1]北京中医药大学东直门医院肾病内分泌二科,北京100700 [2]北京中医药大学东直门医院通州院区肾病内分泌三科,北京101121 [3]中国中医科学院望京医院肾病内分泌科,北京100102 [4]辽宁中医药大学,沈阳110032

出　　处：《重庆医学》2024年第3期333-338,共6页Chongqing medicine

基　　金：国家重点研发计划项目(2018YFC1704400,2018YFC1704402)。

摘　　要：目的探讨2型糖尿病(T2DM)患者并发心脏自主神经病变的危险因素。方法选取2021年9月至2022年2月就诊于北京中医药大学东直门医院内分泌科住院的148例T2DM患者为研究对象,以心血管自主神经反射试验(CARTs)作为糖尿病心脏自主神经病变(DCAN)的诊断标准,根据是否发生DCAN分为DCAN组(96例)和非DCAN组(52例),收集两组一般资料、空腹血糖(FPG)、餐后2小时血糖(2 hPG)、空腹C肽(FCP)、糖化血红蛋白(HbA1c)及心率变异性指标[NN间期标准差(SDNN)、相邻NN间期差的均方根(RMSSD)、心率变异性指数(HRV-index)、高频功率(HF)、低频功率(LF)、极低频功率(VLF)],通过多因素logistic回归筛选T2DM并发DCAN的危险因素。结果与非DCAN组比较,DCAN组年龄更大,病程>15年、糖尿病周围神经病变患者比例更高,FCP、SDNN、RMSSD、HF、LF、VLF更低,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄、糖尿病周围神经病变、FCP、LF是DCAN的独立影响因素(P<0.05)。其中,年龄每增加1岁,T2DM患者发生DCAN的风险增加4.3%(OR=1.043,95%CI:1.006~1.080);合并糖尿病周围神经病变的患者发生DCAN的风险是不合并糖尿病周围神经病变患者的2.577倍(OR=2.577,95%CI:1.003~6.622);FCP每增加1个单位,T2DM患者发生DCAN的风险降低24.0%(OR=0.760,95%CI:0.586~0.988),LF每增加1个单位,T2DM患者发生DCAN的风险降低0.2%(OR=0.998,95%CI:0.995~<1.000)。结论应及时筛查和评估DCAN以改善T2DM患者预后。Objective To investigate the risk factors of cardiac autonomic neuropathy in type 2 diabetes mellitus(T2DM)patients.Methods A total of 148 T2DM patients admitted to the Department of Endocrinology,Dongzhimen Hospital,Beijing University of Chinese Medicine from September 2021 to February 2022 were selected as the research objects.Cardiovascular autonomic reflex tests(CARTs)was used as the diagnostic criteria for diabetic cardiac autonomic neuropathy(DCAN).According to the occurrence of DCAN,they were divided into the DCAN group(96 cases)and the non-DCAN group(52 cases).General data,fasting blood glucose(FPG),2 hours postprandial blood glucose(2 hPG),fasting C-peptide(FCP),glycosylated hemoglobin(HbA1c)and heart rate variability[standard deviation of NN intervals(SDNN),root mean square of standard deviation of NN intervals(RMSSD),heart rate variability index(HRV-index),high frequency power(HF),low frequency power(LF)and very low frequency power(VLF)]of the two groups were collected and screened the risk factors of T2DM with DCAN by multivariate logistic regression.Results Compared with the non-DCAN group,the DCAN group was older,the disease course was longer,the proportion of diabetic peripheral neuropathy patients was higher,and the FCP,SDNN,RMSSD,HF,LF and VLF were lower,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that age,distal symmetric polyneuropathy,FCP and LF were independent influencing factors of DCAN(P<0.05).The risk of DCAN in T2DM patients increased by 4.3%for each year of age increase(OR=1.043,95%CI:1.006-1.080).The risk of DCAN in patients with distal symmetric polyneuropathy was 2.577 times higher than that in patients without distal symmetric polyneuropathy(OR=2.577,95%CI:1.003-6.622).For every 1 unit increase in FCP,the risk of DCAN in T2DM patients decreased by 24.0%(OR=0.760,95%CI:0.586-0.988),and for every 1 unit increase in LF,the risk of DCAN in T2DM patients decreased by 0.2%(OR=0.998,95%CI:0.995-<1.000).Conclusion DCAN should be scre

关 键 词：2型糖尿病 糖尿病心脏自主神经病变 危险因素 心率变异性 心血管反射试验 

分 类 号：R587.2[医药卫生—内分泌]