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目的观察不同年龄段糖尿病伴心血管自主神经病变(CAN)患者心率减速力(DC)和Tpe/QT比值的变化特点并分析影响因素。方法选取糖尿病伴心血管自主神经病变患者(DM+CAN组)287例、糖耐量正常的CAN患者(CAN组)130例及健康体检者(NC组)150名,再根据年龄范围将DM+CAN组行三分位法分组:低分位(35.0~47.2岁)亚组91例、中分位(47.3~59.6岁)亚组116例及高分位(59.7~72.0岁)亚组80例。各组均接受标准12导联心电图和24 h动态心电图检测,计算DC和Tp-e/QT比值并分析两者的影响因素。结果DM+CAN组WC、SBP、BMI、FPG、HbA_1c、FIns及HOMA-IR高于CAN组和NC组(P<0.05或P<0.01)。DM+CAN组、CAN组、NC组,DC依次升高,Tp-e/QT依次降低(P<0.05或P<0.01);高分位亚组和中分位亚组糖尿病病程、WC、FPG、FIns、HbA_1c、HOMA-IR、高血压和冠心病患者比例均高于低分位亚组,高分位亚组糖尿病病程和FIns高于中分位亚组(P<0.05或P<0.01);高分位亚组平均心率(RHR)和静息心率(AHR)均低于低分位亚组(P<0.05),而中分位和低分位亚组比较,差异无统计学意义(P>0.05)。从高分位亚组到低分位亚组,DC逐渐升高[(2.90±0.47)vs(4.22±0.41)vs(4.97±0.35)ms],Tp-e/QT逐渐降低[(0.23±0.05)vs(0.18±0.03)vs(0.12±0.02)](P<0.05或P<0.01);多元逐步回归分析显示,年龄、糖尿病病程、WC、FPG、HbA_1c、合并高血压、合并冠心病是DC和Tp-e/QT比值共同的危险因素(P<0.05)。结论随年龄升高,糖尿病伴心血管自主神经病变患者DC水平降低,Tp-e/QT比值增高。对于年龄高、糖尿病病程长,WC、FPG、HbA_1c水平升高及合并高血压和冠心病的患者可考虑常规进行动态心电图检测,有效预防心血管事件的发生。
Objective To observe the changes of heart rate deceleration (DC) and Tpe / QT ratio in patients with diabetes mellitus and cardiovascular autonomic neuropathy (CAN) of different ages and analyze the influencing factors. Methods 287 diabetic patients with cardiovascular autonomic neuropathy (DM + CAN group), 130 CAN patients with normal glucose tolerance (CAN group) and 150 healthy people (NC group) were enrolled. According to the age range, DM + CAN The patients were divided into three groups: 91 patients in the sub-quantile group (35.0-47.2 years), 116 patients in the sub-median group (47.3-59.6 years) and 80 patients in the high-quantile group (59.7-72.0 years). Each group received standard 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram. The ratios of DC and Tp-e / QT were calculated and the influencing factors were analyzed. Results The levels of WC, SBP, BMI, FPG, HbA_1c, FIns and HOMA-IR in DM + CAN group were higher than those in CAN group and NC group (P <0.05 or P <0.01). DM + CAN group, CAN group, NC group and DC increased in sequence and Tp-e / QT decreased in turn (P <0.05 or P <0.01) , FIns, HbA_1c, HOMA-IR, hypertension and coronary heart disease were higher than those in the low-quantile subgroup. The duration of diabetes mellitus and FIns in the high-titre subgroup were higher than those in the middle subgroup (FI <0.05 or P <0.01) (HR) and resting heart rate (AHR) in the high-quantile subgroup were lower than those in the low-subgroup (P <0.05), while there was no significant difference between the sub-sub-group and the low-subgroup P> 0.05). DC increased gradually from hyperintendent subgroup to lower subgroup [(2.90 ± 0.47 vs 4.22 ± 0.41 vs 4.97 ± 0.35 ms, Tp-e / QT decreased gradually (0.23 ± 0.05 ) (P <0.05 or P <0.01) .Multivariate stepwise regression analysis showed that age, duration of diabetes, WC, FPG, HbA 1c, hypertension complicated with coronary heart disease And Tp-e / QT ratio common risk factors (P <0.05). Conclusion With age, the DC level and the Tp-e / QT ratio in diabetic patients with cardiovascular autonomic neuropathy decrease. For patients with high age, long duration of diabetes, elevated levels of WC, FPG and HbA_1c, and hypertension and coronary heart disease, we should consider routine Holter monitoring to effectively prevent the occurrence of cardiovascular events.