【摘要】 目的观察2型糖尿病、冠心病、2型糖尿病合并冠心病患者心率变异性（HRV）变化及其与心脏结构功能指标的关系。方法选择糖尿病合并冠心病患者33例,2型糖尿病患者32例,冠心病患者32例,健康体检者31例,行24 h动态心电图监测、心脏彩超检查,对HRV时域指标、昼夜节律变化、HRV指标与心脏结构功能指标的相关性等进行分析。结果四组比较2型糖尿病合并冠心病组HRV降低发生率最高,而冠心病组与2型糖尿病组之间则无显著性差异。糖尿病合并冠心病组清醒状态与睡眠状态的HRV指标相比较无明显差异,而对照组各指标睡眠状态均显著高于清醒状态。糖尿病合并冠心病组较T₂DM组、冠心病组LVEF、E/A降低,左心室舒张末期内径（LVEDD）、左心房内径（LA）增大。正常窦性心搏RR间期总体标准差与LA、LVEDD呈负相关,与LVEF、E/A呈正相关;每5 min窦性RR间期均值标准差与LVEDD呈负相关,与LVEF、E/A呈正相关;每5 min RR间期标准差均值与LVEF呈正相关;正常连续窦性RR间期差值均方根与LVEF、E/A呈正相关。结论 2型糖尿病合并冠心病组自主神经损害最严重、心率变异的昼夜节律消失;HRV可反映心脏结构重构的严重程度及心功能的损坏程度。更多还原

【Abstract】 Objective To observe the changes of heart rate variability（ HRV） in patients with type 2 diabetes mellitus（ T₂DM）,coronary heart disease（ CHD）,or T₂ DM and CHD,and its relationship with the index of cardiac structure function. Methods We chose 33 cases of patients with T₂ DM and CHD（ T₂ DM combined with CHD group）,32 patients with T₂DM（ T₂ DM group）,32 patients with CHD（ CHD group）,and 31 cases of healthy controls（ control group）. The24-hour dynamic electrocardiogram and echocardiography were performed to analyze the correlation of the time domain index of HRV,circadian variation and HRV index with cardiac structure function index. Results From comparing the four groups,the T₂ DM combined with CHD group had the highest incidence of HRV decrease,but the CHD group and T₂ DM group had no significant difference in the incidence of HRV decrease. HRV index of the T₂ DM combined with CHD group had no significant difference between awake state and sleeping state,but in the control group,every index of sleeping state was significantly higher than that of the awake state. Compared with the T₂ DM group and CHD group,left ventricular ejection fraction（ LVEF） and E/A of the T₂ DM combined with CHD group decreased,but left ventricular end-diastolic diameter（ LVEDD） and LA increased. Standard deviation of R-R intervals（ SDNN） was negatively correlated with LA and LVEDD,but was positively correlated with LVEF and E/A. SDANN was negatively correlated with LVEDD,but was positively correlated with LVEF and E/A. SDNN index and LVEF was positively correlated. r MSSD was positively correlated with LVEF and E/A. Conclusions Patients with T₂ DM and CHD have the most serious autonomic nerve damage,and the heart rate variation of circadian rhythm is vanished. HRV can reflect the severity of the cardiac remodeling and cardiac function damage.更多还原