2型糖尿病及其并发症与自主神经功能的关系探讨

目的 探讨2型糖尿病（T2DM）及其并发症与自主神经功能的关系。方法 随机选取260例T2DM患者，采用QHRV1-心率变异分析系统进行自主神经功能分析，并对受试者进行周围神经、眼底、尿微量白蛋白的检测。选取同一时期体检的135例正常人，进行QHRV1系统的检查。结果 T2DM患者心率变异性（HRV）的指标SDNN、rMSSD、PNN50、VLF、LF、HF较正常对照组均明显降低（P均<0.01）；T2DM合并冠心病（CAD）组患者的SDNN、rMSSD、PNN50、LF、HF均低于无CAD的T2DM组，交感-副交感神经功能紊乱的百分比高于无CAD的T2DM组（P<0.05）；T2DM并发症较多的观察组SDNN、rMSSD、PNN50、VLF、LF、HF均低于无并发症或并发症较少的观察组，交感-副交感神经紊乱的百分比高于无并发症或并发症较少的观察组（P<0.05或P<0.01）；T2DM并发症的数量与BMI、T2DM病程、自主神经功能紊乱、甘油三酯、SBP呈正相关（P<0.05或P<0.01）；校正性别、年龄、HbA1c、FBG、肝肾功能后，进行多元线性回归分析显示，BMI、T2DM病程、自主神经功能紊乱仍与T2DM并发症的数量密切相关（R²=0.272，P均<0.01）。结论 T2DM患者的心率变异性较正常人降低，自主神经功能的紊乱与冠心病、T2DM微血管以及周围神经病变等并发症的增加有关。

Correlation of Autonomic Nervous Function with Type 2 Diabetes and Its Complications

Objective To investigate the correlation of autonomic nervous function with type 2 diabetes mellitus (T2DM) and its complications.Methods We randomly collected 260 cases of patients with T2DM, who underwent the QHRV1-heart rate variation analysis system for autonomic nervous function analysis, as well as the examinations of peripheral nerve, ocular fundus and urine trace albumin. Meanwhile, 103 normal subjects for physical examination were selected and performed QHRV1-system analysis.Results Indexes of heart rate variability (HRV) included SDNN, rMSSD, PNN50, VLF, LF and HF in T2DM patients were significantly lower than control group(both P<0.01). SDNN, rMSSD, PNN50, LF and HF in T2DM patients with coronary artery disease (CAD) were lower than patients without CAD, and the percentage of sympathetic-parasympathetic disorder was higher than patients without CAD (P<0.05 or P<0.01). SDNN, rMSSD, PNN50, VLF, LF and HF in T2DM patients with more complications were lower than those with no complication or fewer complications, while the percentage of sympathetic-parasympathetic nerves disorder was higher (P<0.05). The number of T2DM complications were positively related to BMI, T2DM duration, autonomic nerve dysfunction, triglycerides and SBP (P<0.05). After adjustment for gender, age, HbA1c, FBG, liver and kidney function, a multiple linear regression analysis showed that BMI, T2DM duration and autonomic nerves dysfunction were still closely related to the number of T2DM complications (R²=0.272, both P<0.01).Conclusion Heart rate variability in T2DM patients was lower than normal subjects. Autonomic nervous dysfunction is closely related to coronary artery disease, microangiopathy and peripheral neuropathy in T2DM patients.