| 姚艺璇,杨 燕,洪秀韬,柳传威,刘卉芳,陈凤玲.2型糖尿病患者心率变异性时域及频域参数与颈动脉粥样硬化的相关性分析[J].,2022,(17):3249-3254 |
| 2型糖尿病患者心率变异性时域及频域参数与颈动脉粥样硬化的相关性分析 |
| Correlation of Time and Frequency Domain Parameters of Heart Rate Variability with Carotid Atherosclerosis in Patients with Type 2 Diabetes Mellitus |
| 投稿时间：2022-02-23 修订日期：2022-03-18 |
| DOI：10.13241/j.cnki.pmb.2022.17.009 |
| 中文关键词: 2型糖尿病 心率变异性 心血管自主神经病变 颈动脉粥样硬化 |
| 英文关键词: Type 2 diabetes mellitus Heart rate variability Cardiovascular autonomic neuropathy Carotid Atherosclerosis |
| 基金项目:国家自然科学基金项目（81670735） |
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| 中文摘要: |
| 摘要 目的：探讨2型糖尿病患者心率变异性（HRV）时域及频域参数与颈动脉粥样硬化（CAS）患病风险的相关性。方法：根据纳入与排除标准共收集2019年7月至2021年8月上海交通大学医学院附属第九人民医院内分泌代谢科住院的377例2型糖尿病患者的临床资料，并通过3分钟的心电图记录HRV时域[R-R间隔的标准差（SDNN）、相邻R-R间隔差值的均方根（RMSSD）、相邻R-R间隔差值>50 ms的数目占所有R-R间隔总数百分比（PNN50）]和频域[低频功率（LF）、高频功率（HF）、LF/HF、总功率（TP）]参数。根据颈动脉超声有无斑块形成分为无CAS组和CAS组，分析其与HRV各参数的关系。结果：与无CAS组相比，CAS组年龄、心血管疾病、体质量指数（BMI）、糖化血红蛋白A1c（HbA1C）、甘油三酯（TG）水平明显升高，舒张压（DBP）、空腹血糖（FPG）水平降低，差异具有统计学意义（P＜0.05）。CAS组大多数HRV参数低于无CAS组，包括SDNN、RMSSD、PNN50、LF、LF/HF、TP，差异有统计学意义（P＜0.05或P＜0.01）。SDNN与年龄、病程、心血管疾病、饮酒呈负相关（P＜0.05或P＜0.01）；RMSSD与病程、饮酒呈负相关（P＜0.05或P＜0.01）；PNN50与病程呈负相关（P＜0.05）；LF与年龄、病程、心血管疾病呈负相关，与DBP、低密度脂蛋白（LDL）呈正相关（P＜0.05或P＜0.01）；HF与年龄、病程呈负相关，与LDL呈正相关（P＜0.05或P＜0.01）；LF/HF与年龄、心血管疾病、TG呈负相关（P＜0.05或P＜0.01）；TP与年龄、病程、心血管疾病呈负相关，与DBP、LDL呈正相关（P＜0.05或P＜0.01）。使用多因素logistic回归对部分可能的混杂因素进行校正后，SDNN、RMSSD、LF、LF/HF、TP降低仍然与CAS发生的风险增加相关（均P＜0.05）。进一步按糖化血红蛋白（≤7.0%、＞7.0%）分层后分析，糖化血红蛋白＞7.0%组的患者SDNN、RMSSD、LF、TP的降低与CAS发生的风险增加相关（P＜0.05），而在糖化血红蛋白≤7.0%组，仅RMSSD、PNN50有统计学意义（P＜0.05）。结论：2型糖尿病患者HRV参数SDNN、RMSSD、LF、TP降低与CAS发生的风险增加有关，且糖化血红蛋白＞7.0%的患者有更多的HRV参数（SDNN、RMSSD、LF、TP）与CAS相关。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between time domain and frequency domain parameters of heart rate variability (HRV) and the risk of carotid atherosclerosis (CAS) in type 2 diabetes mellitus. Methods: According to inclusion and exclusion criteria, clinical data of 377 patients with type 2 diabetes mellitus who were hospitalized in the Department of Endocrinology and Metabolism, Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University from July 2019 to August 2021 were collected. And HRV time domain parameters [Sandard deviation of R-R interval (SDNN), root mean square of the difference of adjacent R-R interval (RMSSD), the percentage of pairs of R-R intervals with >50 ms difference (PNN50)] and frequency domain parameters [low frequency (LF), high frequency (HF), LF/HF, total power (TP)] was recorded by 3-minute electrocardiogram. The patients were divided into non CAS group and CAS group according to whether carotid artery ultrasound found plaque formation or not, and analyzed the relationship between CAS and HRV parameters. Results: Compared with the non-CAS group, age, cardiovascular disease, body mass index (BMI), glycosylated hemoglobin A1c (HbA1C), and triglyceride (TG) levels were higher, while diastolic blood pressure (DBP) and fasting blood glucose (FPG) were lower in the CAS group, and the difference was statistically significant (P<0.05). Most HRV parameters in the CAS group were lower than those in the non CAS group, including SDNN, RMSSD, PNN50, LF, LF/HF, TP, and the differences were statistically significant (P<0.05 or P<0.01). SDNN was negatively correlated with age, course of disease, cardiovascular disease, and drinking (P<0.05 or P<0.01); RMSSD was negatively correlated with course of disease and drinking (P<0.05 or P<0.01); PNN50 was negatively correlated with course of disease (P<0.05); LF was negatively correlated with age, disease course,and cardiovascular disease, and positively correlated with DBP and low-density lipoprotein (LDL) (P<0.05 or P<0.01); HF was negatively correlated with age, disease course, and positively correlated with LDL (P<0.05 or P<0.01); LF/HF was negatively correlated with age, cardiovascular disease, and TG (P<0.05 or P<0.01); TP was negatively correlated with age, disease course, and cardiovascular disease, and positively correlated with DBP and LDL (P<0.05 or P<0.01). After adjusting for some possible confounding factors using multivariate logistic regression, decreased SDNN, RMSSD, LF, LF/HF, and TP were still associated with an increased risk of CAS (all P<0.05). After further stratification by HbA1C (≤7.0%, >7.0%), the reduction of SDNN, RMSSD, LF, and TP in the HbA1C>7.0% group was associated with an increased risk of CAS (P<0.05), while in the group with HbA1C≤7.0% group, only RMSSD and PNN50 were statistically significant (P<0.05). Conclusion: In patients with type 2 diabetes, lower HRV parameters SDNN, RMSSD, LF and TP were associated with a higher risk of CAS, and patients with HbA1C>7.0% had more HRV parameters (SDNN, RMSSD, LF and TP）associated with CAS. |
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