2型糖尿病患者心血管自主神经病变与夜间心律失常的相关
性
陈楚晖;王维敏;金洁雯;顾天伟;陈炜;毕艳;朱大龙
【期刊名称】《中华糖尿病杂志》 【年(卷),期】2018(010)012
【摘要】目的 探讨2型糖尿病(T2DM)患者心血管自主神经病变(CAN)与夜间心律失常的关系.方法 选取2016年1月至2017年4月南京鼓楼医院内分泌科既往无心律失常病史的T2DM住院患者145例(男99例,女46例),根据Ewing试验(卧立位收缩压差、卧立位30/15 RR间期比值、深呼吸RR间期变异率、Valsalva动作RR间期变异率)评分将患者分为CAN组[得分≥2分,66例,(58±8)岁]和非CAN组[得分＜2分,79例,(53±12)岁].采用24 h动态心电图记录患者室性及室上性心律失常的发生次数及发生时间.采用独立样本t检验、卡方检验及Logistic回归分析夜间心律失常与CAN的关系.结果 (1)CAN组患者夜间(23:00～6:00)室性心律失常发生率明显高于非CAN组[36.4％(24/66)比20.3％(16/79),x2=4.926,P＜0.05],且夜间室性心律失常发生率随CAN严重程度增加而上升[正常组、早期病变组和确诊组分别为16.7％(4/24)、21.8％(12/55)、36.4％(24/66),x2=4.522,P＜0.05],白天(6:00～23:00)室性心律失常及24 h室上性心律失常发生率在两组间未见明显差异.(2)夜间室性心律失常组患者深呼吸RR间期变异率、Valsalva动作RR间期变异率及卧立位30/15 RR间期比值均明显变小(t=2.072～2.651,均P＜0.05).(3) Logistic回归分析显示CAN是夜间室性心律失常发生的独立危险因素(OR=1.715,95％CI:1.005～2.927,P＜0.05).结论 CAN是T2DM患者发生夜间室性心律失常的独立危险因素,早期筛查
CAN可能有助于预测T2DM患者心血管不良事件发生率及死亡率.%Objective To explore the relationship between cardiovascular autonomic neuropathy (CAN) and nocturnal arrhythmias in patients with type 2 diabetes mellitus (T2DM).Methods A total of 145 T2DM patients (99 cases for male,46 cases for female)hospitalized in department of endocrinology of Nanjing Drum Tower Hospital without history of arrhythmias were enrolled from January 2016 to April 2017.CAN was diagnosed based on Ewing tests,which include systolic blood pressure responses to lying-to-standing position,heart rate variation during deep breathing,Valsalva maneuver and lying-to-standing test (30:15 ratio).According to the scores from Ewing tests,patients were divided into CAN (+) group [scores≥2,n=66,(58±8) yrs] and CAN(-) [scores＜2,n=79,(53± 12) yrs] group.Ventricular and supraventricular arrhythmic events were recorded with 24h-electrocardiogram.Independent-sample t test,Chi-Square test and Logistics regression were introduced to explore the correlation between nocturnal arrhythmias and CAN.Results (1) Patients with CAN had higher incidence of nocturnal (23:00-6:00)ventricular arrhythmia [36.4％(24/66) vs 20.3％(16/79),x2=4.926,P＜0.05].In addition,patients with higher CAN stages had a higher incidence of nocturnal ventricular arrhythmia [normal group vs early CAN group vs definite CAN group:16.7％(4/24) vs 21.8％(12/55) vs 36.4％(24/66),x2=4.522,P＜0.05].The incidences of ventricular arrhythmia in
daytime (6:00-23:00)and supraventricular arrhythmia in 24 hours had no difference between two groups.(2)The heart rate variability during deep breathing,valsalva ratio and heart rate response to standing (30∶15 ratio) were all lower in patients with nocturnal ventricular arrhythmias,compared with patients with nocturnal eurhythmia (t=2.072-2.651,all P＜0.05).(3)Logistic regression analysis indicated CAN was an independent risk factor of nocturnal ventricular arrhythmias (OR=1.715,95％CI:1.005-2.927,P＜0.05).Conclusions CAN is an independent risk factor of nocturnal ventricular arrhythmias in patients with T2DM,which suggests early screening of CAN may be important for forecasting adverse cardiovascular events and mortality. 【总页数】5页(783-787)
【关键词】糖尿病,2型;危险因素;心血管自主神经病变;夜间室性心律失常 【作者】陈楚晖;王维敏;金洁雯;顾天伟;陈炜;毕艳;朱大龙
【作者单位】210008 南京大学医学院附属鼓楼医院内分泌科;210008 南京大学医学院附属鼓楼医院内分泌科;210008 南京大学医学院附属鼓楼医院内分泌科;210008 南京大学医学院附属鼓楼医院内分泌科;210008 南京大学医学院附属鼓楼医院内分泌科;210008 南京大学医学院附属鼓楼医院内分泌科;210008 南京大学医学院附属鼓楼医院内分泌科 【正文语种】中文 【中图分类】 【文献来源】
2型糖尿病患者心血管自主神经病变与夜间心律失常的相关性
