非酒精性脂肪肝患者发生2型糖尿病危险因素分析

目的探讨非酒精性脂肪肝（NAFLD）患者发生2型糖尿病的危险因素。方法选择38例非酒精性脂肪肝伴初诊2型糖尿病（DFL）患者,并与26例非酒精性脂肪肝（NAFLD）患者进行比较,对两组的相关变量进行多因素Logistic回归分析。结果27个变量中,单因素Logistic回归分析显示糖尿病家族史、体重指数、业余锻炼、婚姻状况、脂肪肝病程、甜食、甘油三酯、载脂蛋白A1、空腹胰岛素、餐后2小时胰岛素、C肽（CP）、胰岛素抵抗指数、空腹血糖、餐后2小时血糖在两组间差异有显著性;多因素Logistic回归分析显示家族关系、业余锻炼、甜食、甘油三酯、载脂蛋白A1、餐后2小时胰岛素、空腹血糖及餐后2h血糖具有统计学意义。结论糖尿病家族史、甜食、高甘油三酯、高载脂蛋白A1及餐后2小时胰岛素降低是非酒精性脂肪肝患者发生2型糖尿病危险因素,而业余锻炼是其保护因素。     

2型糖尿病合并缺血性心脏病患者的心率变异性研究

目的探讨2型糖尿病和2型糖尿病合并缺血性心脏病患者对心血管自主神经活动的影响。方法用24h动态心电图检测2型糖尿病患者48例，2型糖尿病合并心肌缺血患者35例及对照组43例健康人的心率变异性（HRV）指标。结果2型糖尿病患者心率变异性指标比正常人明显减低，合并心肌缺血比没有合并心肌缺血的2型糖尿病患者，心率变异性指标仅rMSSD、PNN50减低。结论2型糖尿病患者存在植物神经损害，心率变异性减低，心率变异性减低程度与心脏损害程度有关。合并心肌缺血患者对心血管自主神经损害较没有合并心肌缺血者重。     

心率变异性分析对Ⅱ型糖尿病病人心脏自主神经功能的探讨

心率变异性(HRV)是一种简单、无创评估心脏自主神经功能的方法。本文对30例Ⅱ型糖尿病(NIDDM,下同)者(A组)与35例正常人(B组)的HRV资料作分析。结果 A组的HRV降低(P<0.05),合并有心肌缺血者,HRV明显低下(P<0.05)。体位改变后,B组的LF/HF比值上升,A组的LF/HF比值下降,提示A组病人自主神经径路受损,迷走神经张力减低,自主神经调节功能低下。HRV的应用为糖尿病性神经病变的诊断、评估疾病的发展、预后提供了参考依据。     

心率变异分析仪在2型糖尿病心血管自主神经病变中的诊断价值

目的 探究麦笛亚心率变异分析仪(Medeia 3000)在2型糖尿病(T2DM)心血管自主神经病变(CAN)中的诊断价值。方法 纳入T2DM患者338例，分别采用人工方法及Medeia 3000进行心血管自主神经功能反射试验(CARTs),根据CAN诊断标准，将所有患者分为非CAN组(NCAN组，81例)、早期CAN组(ECAN组，105例)及CAN组(152例),收集所有患者的一般临床资料及实验室检查指标并分组进行比较。采用spearman相关分析评估两种方式检测结果的相关性。采用受试者工作特征(ROC)曲线分析Medeia 3000对T2DM CAN的诊断价值。结果 ECAN组患者年龄、BUN及OC水平均高于NCAN组，eGFR低于NCAN组；CAN组患者年龄、糖尿病病程、BUN及UACR均高于NCAN组，eGFR、UA、白蛋白均低于NCAN组；CAN组患者年龄、糖尿病病程及UACR均高于ECAN组，白蛋白、β-CTX及PⅠNP均低于ECAN组(P<0.05)。Medeia 3000检测CARTs评分低于人工方法，深呼吸心率差得分、Valsalva指数得分及卧立位心率比值得分...     

心率变异评价新疆维吾尔族2型糖尿病患者的自主神经功能

目的　探讨新疆维吾尔族2型糖尿病(T2DM)患者自主神经病变与心率变异(HRV)及其他脏器受损的关系。　方法　选择确诊为 T2DM的 150 例维吾尔族住院患者,其中单纯糖尿病(SDM)组72例,合并心血管疾病的糖尿病(DC)组78例,病程 <5年组54例,5~10年组51例,>10年组45例。正常对照(NC)组为健康的维吾尔族人 60 名,全部进行 24 h动态心电图及 HRV分析。　结果　T2DM患者HRV均小于NC组(t'= 6.5366~9.5677, P<0.05 ),DC组的 HRV较 SDM组低(t=4.0791~8.9233,P<0.05 ),病程>5 年的两组患者所有正常 R R间期的标准差值均低于病程<5年组(t=7.5935~10.631,P<0.05 )。　结论　HRV是早期判断维吾尔族 T2DM患者自主神经病变最准确而又最敏感的方法,可能对是否合并心脏缺血性病变有提示作用。     

2型糖尿病治疗前后心率变异性分析

目的：观察2型糖尿病（type 2 diabetes mellitus,T2DM）患者治疗前后心率变异性（heart rate variability,HRV）的变化。方法选取48例T2DM患者作为糖尿病组,另选取50例健康志愿者作为对照组。观察 T2DM患者治疗前后 HRV 时域指标 SDNN、SDANN、rMSSD、PNN50和HRV频域指标LF、HF、LF／HF、VLF的变化,并与对照组比较。结果糖尿病组治疗前HRV时域和频域指标均低于对照组（P＜0．05）;与治疗前相比,糖尿病组治疗后HRV时域指标SDNN、SDANN、rMSSD、PNN50和 HRV 频域指标 LF、HF、VLF 均有不同程度的改善（P＜0．05）。结论 T2 DM患者存在心脏自主神经调节功能异常,以迷走神经受损为主,治疗后自主神经调节功能有不同程度的恢复。     

2型糖尿病患者自主神经病变诊断方法的临床研究

目的　研究 2型糖尿病 (T2 DM)患者自主神经病变症状、心血管反射试验 (CRT)、心率变异性 (HRV)之间的关系。方法　选取 2 0 0 2 - 0 3～ 2 0 0 3- 0 5昆明医学院第二附属医院门诊及住院的 5 0例T2 DM患者 ,分为无症状 (DANS-)组和有症状 (DANS )组 ,CRT阴性 (CRT-)组和CRT阳性 (CRT )组 ,4 0例健康人为对照组 ,进行HRV频域分析。结果　DANS 组、DANS-组及对照组之间HRV值有明显变化 (P <0 .0 5 )。CRT-组较对照组HRV值明显改变 (P <0 0 5 ) ,而CRT 组较CRT-组显著改变 (P <0 0 1)。结论　HRV频域分析可以早期发现T2 DM患者自主神经病变。     

心力衰竭患者自主神经功能与临床相关因素的研究

本研究通过对不同病因的慢性心力衰竭 (心衰 )患者的心率变异性 (HRV)分析 ,探讨慢性心衰患者自主神经功能活动与心功能受损的严重程度及其临床诸因素的相关性。1.资料与方法 :1999年 1月～ 2 0 0 1年 6月门诊或住院患者共 97例 ,分为两组 :(1)对照组 35例 ,男2 3例 ,女 12例 ,年龄 2 6～ 75 (5 5± 11)岁 ,无器质性心脏病。 (2 )慢性心衰组 6 2例 ,男 4 2例 ,女 2 0例 ,年龄 2 8～ 82 (5 7± 13)岁 ,其中高血压病 16例、冠心病13例、高血压合并冠心病 13例、病毒性心肌炎 7例、肺原性心脏病 6例、扩张性心肌病 5例、风湿性心脏病 2例。所…     

2型糖尿病患者心率变异性与视网膜病变关系的研究

观察不并发和并发视网膜病变的2型糖尿病患者的心率变异性(HRV)，糖尿病并发视网膜病变者HRV显著降低，HRV变化与糖尿病视网膜病变相关。     

原发性高血压伴2型糖尿病患者的心率变异分析

目的探讨原发性高血压(EH)与原发性高血压伴2型糖尿病(EH+T2DM)患者自主神经功能变化和二者之间的心率变异。方法选取我院心内科住院的EH病人42例为EH组:30例EH+T2DM病人为EH+T2DM组;40例健康人为对照组。作24小时动态心电图记录,进行HRV分析。结果EH组、EH+T2DM组及对照组之间HRV有明显变化,(P<0.05);EH组较对照组HRV值明显改变(P<0.05);而EH+T2DM组较EH组之HRV值显著降低,(P<0.05)。结论EH组较对照组自由神经功能损害明显,EH+T2DM患者较单纯EH者自主神经功能损害更明显。     

Melatonin levels decrease in type 2 diabetic patients with cardiac autonomic neuropathy

The present study has been designed to determine melatonin levels in type 2 diabetic patients and test the relationship between the autonomic nervous system and melatonin dynamics. Thirty-six type 2 diabetic patients and 13 age-matched healthy subjects were recruited for the study. Circadian rhythm of melatonin secretion was assessed by measuring serum melatonin concentrations between 02:00-04:00 and 16:00-18:00 hr. Melatonin dynamics were re-evaluated with respect to autonomic nervous system in diabetic patients with autonomic neuropathy who were diagnosed by the cardiovascular reflex tests, heart rate variability (HRV), and 24-hr blood pressure monitoring. Nocturnal melatonin levels and the nocturnal melatonin surge were low in the diabetic group (P = 0.027 and 0.008 respectively). Patients with autonomic neuropathy revealed decreased melatonin levels both at night and during day when compared with healthy controls (P < 0.001 and 0.004 respectively) while the melatonin dynamics were similar to controls in patients without autonomic neuropathy. Nocturnal melatonin level was positively correlated with nocturnal high and low frequency components of HRV (P = 0.005 and 0.011 respectively) and systolic and diastolic blood pressures at night (P = 0.002 and 0.004 respectively) in patients with autonomic neuropathy. We found a negative correlation between nocturnal melatonin levels and the degree of systolic blood pressure decrease at night (r = -0.478, P = 0.045). As a conclusion this study has shown that circadian rhythm of melatonin secretion is blunted in type 2 diabetic patients and there is a complex relationship between various components of autonomic nervous system and melatonin secretion at night. Among the patients with autonomic neuropathy those with more preserved HRV and the systolic nondippers (<10% reduction in blood pressure during the night relative to daytime values) have more pronounced melatonin surge at night.     

2型糖尿病心脏自主神经病变临床特征和危险因素分析

目的探讨2型糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,DCAN)的临床特征及相关危险因素。方法纳入2012年2月至2013年1月在广东省人民医院内分泌科就诊的2型糖尿病患者47例(按1999年世界卫生组织建议的糖尿病诊断标准),所有2型糖尿病患者进行葡萄糖耐量试验(OGTT)、胰岛素释放试验、血脂等分析,并以Ewing试验作为诊断DCAN的标准,对DCAN的患病情况、临床特征及可能的主要危险因素进行分析。同时,招募糖耐量正常者19例设为正常对照组。结果以Ewing试验为标准诊断心脏自主神经病变(cardiac autonomic neuropathy,CAN),正常对照组CAN的患病率仅为5.3%(1/19),2型糖尿病组为55.3%(26/47),两组比较差异有统计学意义(P=0.001)。2型糖尿病组中病程≤5年患者的DCAN患病率为45.2%(14/31),>5年患者为75.0%(12/16),两者比较差异有统计学意义(P=0.051)。2型糖尿病组中DCAN患者心率、收缩压、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、尿酸与正常对照组患者比较,差异有统计学意义(P<0.05)。静息心率>80次/min、收缩压>140 mm Hg(1 mm Hg=0.133 kPa)、空腹胰岛素>100 pmol/L、胰岛素抵抗指数>5.3或胰岛素分泌指数>102.65、尿酸>350μmol/L的患者的DCAN患病率均较正明显增加,均差异有统计学意义(P<0.05)。Logistic回归分析显示,糖化血红蛋白(HbA1c)(OR=11.788)、胰岛素抵抗指数(OR=17.211)、尿酸(OR=5.757)是DCAN的主要独立危险因素。结论 2型糖尿病患者是CAN的高危人群;糖化血红蛋白、胰岛素抵抗指数、尿酸是DCAN的主要独立危险因素。     

Cardiovascular autonomic neuropathy associated with carotid atherosclerosis in Type 2 diabetic patients.

AIMS: To clarify if cardiovascular autonomic neuropathy is associated with carotid artery atherosclerotic plaques in Type 2 diabetic patients. METHODS: Cardiovascular autonomic nerve function was related to carotid artery ultrasound in 61 Type 2 diabetic patients 5-6 years after diagnosis of diabetes. RESULTS: Cardiovascular autonomic neuropathy [abnormal age corrected expiration/inspiration (E/I) ratio or acceleration index (AI)] was found in 13/61 (21%) patients. Patients with cardiovascular autonomic neuropathy showed increased degree of stenosis in the common carotid artery (24.6 +/- 13.2% vs. 14.7 +/- 9.2%; P = 0.014) and a tendency towards a higher plaque score (4.0 +/- 1.7 vs. 3.2 +/- 1.6; P = 0.064). Controlled for age, AI correlated inversely with degree of stenosis (r = -0.39; P = 0.005), plaque score (r = -0.39; P = 0.005), and mean (r = -0.33; P = 0.018) and maximum (r = -0.39; P = 0.004) intima-media thickness in the common carotid artery. In contrast, E/I ratio correlated only slightly with mean intima-media thickness in the common carotid artery (r = -0.28; P = 0.049). CONCLUSIONS: Cardiovascular autonomic neuropathy was associated with carotid atherosclerosis in Type 2 diabetic patients. Abnormal E/I ratios reflect efferent structural damage to parasympathetic nerves whereas abnormal AI reflects afferent autonomic dysfunction possibly due to impaired baroreceptor sensitivity secondary to carotid atherosclerosis.     

2型糖尿病患者胃动力学与植物神经病变关系的探讨

目的研究胃动力障碍及植物神经病变与2型糖尿病(DM2)的关系。方法采用半流质核素胃排空试验对129例DM2患者的胃动力进行了研究,同时还用Ewing法对心血管植物神经功能、用B超对膀胱残余尿量、用神经病星对外周神经进行定量测定。结果糖尿病胃排空延迟发生率为62.02％。植物神经病变呈弥漫性分布,随病程延长而加重。胃动力异常者,其植物神经病变发生率较胃动力正常者显著增高。结论DM2胃动力异常及植物神经病变发生率均明显增高,二者显著相关。故早期进行胃排空试验,并同时对其它植物神经功能进行测定,对糖尿病胃及神经并发症的早期防治有重要意义。     

Assessment of cardiac autonomic neuropathy in long standing type 2 diabetic women

BackgroundPatients with long standing DM undergoing surgical interventions are put under great challenge as they may have cardiovascular and/or cardiac autonomic neuropathy (CAN). CAN is serious, often overlooked and under diagnosed, with possible arrhythmias and silent ischemia that threaten life.ObjectivesAssessment of CAN in long standing type 2 diabetic women undergoing major surgery.Study designCross sectional study.Patients and methodsOne hundred and six type 2 diabetic women scheduled for major surgery were assessed by the autonomic function tests. Only one hundred cases completed the study. CAN was assessed by analyzing HR variations during three standard tests (deep breathing, lying to standing and valsalva maneuver). Sympathetic functions were assessed by checking orthostatic hypotension. The CAN score of each patient was analyzed. Continuous 24 hour ECG monitoring (Holter) was done to evaluate ischemia, arrhythmia, QTc and QTd. Transthoracic Doppler echocardiography, stressing on LVH, diastolic and systolic dysfunctions were carried out. Cases were classified as mild (with only one abnormal test) or severe CAN when two or more abnormal function tests were present. Exclusion criteria include any systemic illness that can affect the study results or the autonomic functions, smoking and HTN.ResultsCAN was detected in 70% of the studied cases, and 70% were severe CAN. Postural hypotension was detected in 34% of the studied cases. QTc prolongation and QT dispersion were frequent. ECG and Doppler echocardiography changes of LVH were more prevalent among patients with CAN. Diabetics with CAN were significantly older had longer duration of DM and higher HbA1-c, higher pulse pressure, triglyceride, uric acid and urinary albumin excretion rate. They also had significant increased LVM index, diastolic dysfunction and myocardial ischemia.ConclusionMiddle aged women with long standing diabetes are vulnerable to CAN with postural hypotension and prolonged QTc intervals, QT dispersion, and increased LVMI and myocardial ischemia. Identification of CAN is crucial to exercise prevention against hazards of CV insults during stressful situation as surgery.     

Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus

Aims/hypothesis Cardiac autonomic neuropathy (CAN) is associated with increased morbidity and mortality in type 1 diabetes. Apart from glycaemic control, risk factors for CAN have not been extensively studied.Methods As part of the EURODIAB Prospective Complications Study, CAN—defined as either a loss of heart rate variability or postural hypotension on standing—was assessed at baseline and follow-up (7.3±0.6 years from baseline) in patients with type 1 diabetes.Results Follow-up measurements were available for 956 participants without CAN at baseline (age at baseline 31.3±8.9 years, duration of diabetes 13.5±8.3 years). During follow-up, 163 (17%) subjects developed CAN, yielding an incidence of 23.4 per 1,000 person-years. Blood pressure, weight, the presence of cardiovascular disease, albuminuria, distal symmetrical polyneuropathy (DSP) and retinopathy at baseline were associated with the incidence of CAN after adjustment for sex, duration of diabetes and HbA₁c. In a multivariate regression model, baseline factors associated with an increased risk of developing CAN were age [odds ratio (OR)=1.3 per decade, 95% CI 1.1–1.7], HbA₁c (OR=1.2 per percentage point, 95% CI 1.1–1.4), systolic blood pressure (OR=1.1 per 10 mmHg, 95% CI 1.0–1.3), feeling faint on standing (OR=2.0, 95% CI 1.2–3.2), DSP (OR=1.9, 95% CI 1.2–3.0) and retinopathy (OR=1.7, 95% CI 1.1–2.6).Conclusion/interpretation This study confirms the importance of exposure to hyperglycaemia as a risk factor for CAN. A small set of variables, including HbA₁c, hypertension, DSP and retinopathy, predict the risk of CAN. Clinical trials are needed to address the impact of intensive antihypertensive treatment on CAN in type 1 diabetes.     

Dissociated sensory loss in diabetic autonomic neuropathy.

Aims: Clinical observation has led to the idea that there might be a distinctive form of selective sensory and autonomic neuropathy affecting patients with Type 1 diabetic mellitus with severe symptomatic autonomic neuropathy (Type 1-DAN) and this study was conducted to evaluate the presence of such a neuropathy in Type 1-DAN. METHODS: Nineteen Type 1 diabetic patients presenting for treatment of severe symptomatic autonomic neuropathy were examined (all had > or = 2 autonomic symptoms; age 39.3 +/- 10.2 years; duration of disease 25.6 +/- 10.5 years). For comparison, 19 Type 1 diabetic patients with neuropathic foot ulcers (age 44.5 +/- 6.6 years; duration of disease 26.7 +/- 9.2 years), 14 clinically uncomplicated Type 1 diabetic patients (age 39.9 +/- 5.6 years; duration of disease 22.9 +/- 9.3 years) and 16 non-diabetic healthy people as controls (age 39.3 +/- 10.7 years) were also examined. Results The large fibre modalities (light touch and vibration perception) were better preserved in the Type 1-DAN group than in the foot ulcer group. Thus, light touch sensation was normal in 11 out of 19 Type 1-DAN patients compared to only three out of 19 foot ulcer patients (P < 0.01), and vibration perception was 24.9 +/- 15.0 V and 40.5 +/- 7.9 V, respectively (P < 0.002) with some of the Type 1-DAN patients in the normal range. In contrast, the small fibre modalities, thermal perception and autonomic function, were grossly abnormal in both groups (hot thermal perception 14.1 +/- 2.5 degrees C and 12.6 +/- 3.7 degrees C; cold thermal perception 13.8 +/- 2.7 degrees C and 10.9 +/- 4. 7 degrees C; heart rate variation 2.9 +/- 1.5 beats/min and 4.8 +/- 4.0 beats/min, respectively). CONCLUSIONS: There is indeed a subgroup of Type 1 diabetic neuropathy patients who suffer from severe autonomic symptoms associated with a selective small fibre sensory and autonomic loss with relatively preserved large fibre sensory modalities.     

Screening for diabetic cardiac autonomic neuropathy using a new handheld device

Background

Cardiac autonomic neuropathy (CAN) is a serious complication of longstanding diabetes and is associated with an increased morbidity and reduced quality of life in patients with diabetes. The present study evaluated the prevalence of CAN diagnosed by reduced heart rate variability (HRV) using a newly developed device in a large, unselected, hospital-based population of patients with diabetes.

Methods

The study examined 323 patients consisting of 206 type 1 diabetes (T1DM) patients and 117 type 2 diabetes (T2DM) patients. The new handheld prototype Vagus™ was used to screen for CAN. Three different standardized cardiac reflex tests were performed to calculate HRV: 30:15 ratio, E:I ratio, and the Valsalva maneuver. An abnormal HRV in one test is indicative of early CAN, and if two or more tests show abnormal HRV, the diagnosis of CAN is established.

Results

In total, 86% of examined patients completed all three tests. Each test was completed by more than 90% of the patients. The prevalence of established CAN was 23%, whereas 33% of the patients had early signs of CAN. The prevalence was higher in T2DM patients (27.8%) than in T1DM patients (20.6 %), p = .02. Patients with CAN were older and had a longer duration of diabetes, higher systolic blood pressure, more nephropathy and retinopathy, and a higher vibration threshold.

Conclusions

Cardiac autonomic neuropathy is frequent in both T2DM and T1DM patients, especially in those with other late diabetes complications. Screening for CAN with the new device is feasible.     

2型糖尿病患者无症状心肌缺血心率变异性的研究

目的冠心病是2型糖尿病主要心血管并发症,且经常表现为无症状心肌缺血（SMI）,本研究观察2型糖尿病患者SMI发作与心率变异性的相关性。方法在我院行运动负荷心肌灌注显像检查的患者中,选取1个月内做过动态心电图监测的157名无冠心病临床症状的2型糖尿病患者,其中34例为SMI患者;123例为无心肌缺血发作患者,并在其中随机选37例为对照组。结果SMI的发生率为21．6％;SMI组除24小时平均心率高于无心肌缺血组外。心率变异性各参数中：总体标准差、均值标准差、标准差均值、差值的均方根和差值〉50ms的百分比与无心肌缺血组相比较均明显下降。结论心率变异性减低与2型糖尿病合并SMI明显相关,而心率变异性减低作为评价心脏神经自主病变的早期信号,说明2型糖尿病合并SMI的发病与心脏自主神经病变密切相关,心率变异性或可作为无症状的2型糖尿病患者SMI筛查的指标之一。