【作者】 徐蔷； 陈莉明； 常宝成； 单春艳；

【Author】 XU Qiang;CHEN Li-ming;CHANG Bao-cheng;SHAN Chun-yan;Tianjin Medical University Metabolic Diseases Hospital;

【机构】 天津医科大学代谢病医院；

【摘要】 目的:了解糖尿病合并下肢神经病变患者的自主神经功能。方法:根据WHO周围神经病试验组(WHOPNTF)关于糖尿病周围神经病变(DPN)科研诊断标准,将2型糖尿病患者117例分为2型糖尿病组(糖1组)59例和2型糖尿病伴下肢神经病变组(糖2组)58例。对照组50例为无糖尿病的健康查体者。受试者行24小时动态心电图检查,利用软件分析心率变异性时域指标及其昼夜节律。将神经肌电图检查所获得的双下肢神经传导速度的指标与心率变异性时域指标的数据进行相关性分析。结果:(1)与对照组相比,糖尿病组、糖尿病伴下肢神经病变组心率变异性的时域指标SDNN、SDANN、SDNNIDX、rMSSD、pNN50都明显减小(P<0.05)。与糖尿病组相比,糖尿病伴下肢神经病变组心率变异性时域指标SDNN、SDANN、SDNNIDX减小显著(P<0.05)。(2)对照组的时域指标SDNN昼夜变化呈日高夜低,指标rMSSD、pNN50表现为日间降低夜间升高,昼夜差异具有统计学意义(P<0.05);单纯糖尿病组昼夜节律发生改变,SDNN的昼夜差异不具有统计学意义(P>0.05),指标rMSSD和pNN50仍表现为日低夜高(P<0.05);糖尿病伴下肢神经病变组时域指标昼夜节律消失。(3)糖尿病患者心率变异性的时域指标SDNN、SDANN、SDNNIDX与下肢神经传导的速度呈正相关(P<0.05)。结论:糖尿病周围神经病变发生前,糖尿病患者已存在自主神经功能受损。糖尿病伴下肢神经病变患者自主神经功能受损更明显。心率变异性时域指标与神经电生理检查的数据的相关性提示2型糖尿病下肢神经病变和自主神经病变密切相关。心率变异性指标是筛查自主神经损害的可行指标。更多还原

【Abstract】 Objective:To investigate autonomic nervous function of type 2 diabetes with lower extremity neuropathy and heart rate variability.Methods:117 type 2 diabetic subjects and 50 volunteers were recruited in the study.HRV and its CR were determined from 24-hour Holter recording.DM subjects were checked with electroneuromyography.Results:(1) There were significant difference in timing domain parameter of HRV among control subjects,DM and DM with lower extremity neuropathy.Compared with DM 1 group,SDNN,SDANN and SDNNIDX decreased significantly in DM 2 group(P<0.05).(2)CR of HRV in control group was decreased in daytime and increased in night time,but SDNN was increased in daytime and decreased in nighttime.CR of HRV were changed in DM 1 and disappeared in DM 2.(3) Timing domain parameter of HRV were positively correlated to nerve conduction velocity.Conclusion:HRV can provide assistance in assessing autonomic nervous function of type 2 diabetes and type 2 diabetes with lower extremity neuropathy in early stages.更多还原