摘要
目的探讨动态心电图诊断2型糖尿病患者心脏自主神经病变(DCAN)的临床意义。方法260例2型糖尿病患者,均进行动态心电图检查和心血管反射试验,根据Ewing评分不同分为DCAN组(89例)和非DCAN组(171例)。比较DCAN组与非DCAN组患者动态心电图参数{心率变异性(HRV)频域[高频(HF)、低频(LF)、极低频(VLF)、超低频(ULF)]、HRV时域[24 h正常窦性心搏RR间期标准差(SDNN)、每5分钟正常RR间期均值的标准差(SDANN)、相邻正常RR间期差值均方根(rMSSD)、相邻正常RR间期相差超过50 ms的心搏数占总窦性心搏数的百分比(pNN50)]、最大校正后QT间期(QTC)、心率减速力(DC)},分析2型糖尿病患者并发DCAN的影响因素,分析动态心电图对2型糖尿病患者并发DCAN的诊断效能。结果DCAN组SDNN(125.73±16.31)ms、SDANN(99.67±11.77)ms、rMSSD(63.36±7.31)ms、pNN50(13.45±1.76)%、DC(4.77±0.56)ms低于非DCAN组的(144.61±18.70)ms、(118.70±13.94)ms、(67.29±7.46)ms、(16.87±2.19)%、(6.02±0.79)ms,最大QTC(456.65±36.68)ms高于非DCAN组的(413.72±39.56)ms,差异有统计学意义(P<0.05);两组HF、LF、VLF、ULF比较,差异无统计学意义(P>0.05)。经Logistic回归分析结果显示,动态心电图参数SDNN、SDANN、rMSSD、pNN50、DC、最大QTC均为2型糖尿病患者并发DCAN的影响因素(OR=0.940、0.907、0.930、0.420、0.040、1.022,P<0.05)。绘制受试者工作特征曲线(ROC曲线)发现,动态心电图参数SDNN、SDANN、pNN50、DC、最大QTC诊断2型糖尿病患者并发DCAN的曲线下面积(AUC)分别为0.773、0.853、0.885、0.904、0.791,均有一定诊断价值。结论动态心电图参数SDNN、SDANN、rMSSD、pNN50、DC、最大QTC均为2型糖尿病患者并发DCAN的影响因素,对诊断2型糖尿病患者DCAN具有一定的意义。
Objective To explore the clinical significance of holter electrocardiogram in the diagnosis of patients with type 2 diabetic cardiac autonomic neuropathy(DCAN).Methods All 260 patients with type 2 diabetes mellitus underwent holter electrocardiogram and cardiovascular reflex tests,and were categorized into DCAN group(89 patients)and non-DCAN group(171 patients)according to different Ewing scores.Comparison of holter electrocardiographic parameters{heart rate variability(HRV)frequency domain[high frequency(HF),low frequency(LF),very low frequency(VLF),ultra-low frequency(ULF)],HRV time domain[standard diviation of RR intervals(SDNN),standard diviation average of NN intervals(SDANN),root mean square of the successive normal sinus R-R interval difference(rMSSD),percentage difference between adjacent NN intervals more than 50 ms(pNN50)],maximum corrected QT interval(QTC),and deceleration capacity of rate(DC)}between DCAN group and non-DCAN group;analysis of influencing factors of DCAN in patients with type 2 diabetes mellitus,and the diagnostic efficiency of holter electrocardiogram in patients with type 2 diabetes mellitus complicating DCAN.Results DCAN group had SDNN of(125.73±16.31)ms,SDANN of(99.67±11.77)ms,rMSSD of(63.36±7.31)ms,pNN50 of(13.45±1.76)%,and DC of(4.77±0.56)ms,which were lower than(144.61±18.70)ms,(118.70±13.94)ms,(67.29±7.46)ms,(16.87±2.19)%,and(6.02±0.79)ms in non-DCAN group;DCAN group had a higher maximum QTC of(456.65±36.68)ms than(413.72±39.56)ms in non-DCAN group;the difference was statistically significant(P<0.05).There was no significant difference in HF,LF,VLF and ULF between the two groups(P>0.05).Logistic regression analysis showed that holter electrocardiogram parameters SDNN,SDANN,rMSSD,pNN50,DC and maximum QTC were the influencing factors of DCAN in patients with type 2 diabetes mellitus complicating DCAN(OR=0.940,0.907,0.930,0.420,0.040,1.022;P<0.05).Receiver operating characteristic(ROC)curve was drawn and it was found that the area under the curve(AUC)of holter electrocardiogram parameters SDNN,SDANN,pNN50,DC and maximum QTC in diagnosing patients with type 2 diabetes mellitus complicating DCAN were 0.773,0.853,0.885,0.904 and 0.791,all of them had certain diagnostic value.Conclusion Dynamic electrocardiogram parameters SDNN,SDANN,rMSSD,pNN50,DC,and maximum QTC are all influential factors for DCAN in type 2 diabetes mulllitus patients,and have certain significance for the diagnosis of patients with type 2 diabetes mellitus complicating DCAN.
作者
张红英
范霖
ZHANG Hong-ying;FAN Lin(Department of General Practice,Yandong Community Health Service Station of Jinan Lixia District People's Hospital,Jinan 250013,China)
出处
《中国实用医药》
2025年第11期60-63,共4页
China Practical Medicine
关键词
2型糖尿病
心脏自主神经病变
动态心电图
Type 2 diabetes mellitus
Cardiac autonomic neuropathy
Holter electrocardiogram
