糖尿病心脏自主神经病变程度与心肌缺血发生和严重性的关系

目的：观察不同程度糖尿病心脏自主神经病变（DCAN）患者相应的心肌缺血情况，探讨病变程度与心肌缺血的关系。方法：根据心血管自主神经功能试验（立卧位30／15比值、深呼吸，12,率差、Valsalva动作反应指数、立卧位收缩压差）评分值，将140例2型糖尿病患者分为心血管自主神经功能正常组（正常组）和DCAN早期组、确诊组、严重组4组，均进行24h动态心电图（DCG）检查，分析心率、ST-T变化。结果：正常组无痛性ST段压低发生率为10．2％，DCAN早期组为12．1％，DCAN确诊组为23．8％，DCAN严重组达31.3％；无DCAN患者心肌缺血主要发生在上午，有DCAN者则弥散到全天；DCAN越严重，DCG中最快心率值越低（P〈0．05），心率变异越小（P〈0．01）。结论：随DCAN严重性增加，心率变异减小，心肌缺血尤其是无痛性心肌缺血的发生率和严重性增加；DCG是较好的早期诊断心肌缺血的方法。

Correlation between diabetic cardiac autonomic neuropathy and occurrence and severity of myocardiac ischemia

Objective To investigate the relationship between diabetic cardiac autonomic neuropathy （DCAN） and myocardiac ischemia in diabetic patients with various degree of DCAN. Methods One hundred and forty patients with type 2 diabetes mellitus were divided into normal group （normal autonomic nerve function）, early DCAN group, definite DCAN group and severe DCAN group ,according to the results of cardiac autonomic nerve function tests including 30：15 postural ratio, heart rate change with deep respiration, response index of Valsalva maneuver, and postural systolic blood pressure change. All these patients underwent 24 h dynamic electrocardiography （DCG） and their heart rate and ST-T change were analyzed. Results The prevalence of silent ST depression was 10.2% in normal group, 12.1% in early DCAN group,23.8% in definite DCAN group, and 31.3% in severe DCAN group. Silent ST depression occurred mainly in the morning in normal group, but it was disseminated in whole day in patients with DCAN. The heart rate change had correlation with DCAN, the severer the DCAN, the slower the maximal heart rate recorded in DCG （P〈0.05） and the less the heart rate variation （P〈0.01）. Conclusions The prevalence and severity of myocardiac ischemia, especially silent ischemia, increase in the diabetic patients with DCAN and the variation of heart rate decrease with the increase in severity of DCAN. DCG is a fairly good method for the early diagnosis of myocardial isehemia in the patients.