老年糖尿病心脏植物神经障碍时心率变化测定的临床意义

植物神经病变是糖尿病常见的并发症,近年来对其研究逐渐增多,但对老年糖尿病植物神经障碍有关文章报导甚少。我们以两种心率变化(深呼吸差和立卧位差)为指标,对老年糖尿病人心脏植物神经功进行测定,并分析其功能紊乱和老年糖尿病人的年龄、病程、控制程度及糖尿病其它并发症(视网膜病变、神经病变及蛋白尿)的关系,并进一步探讨老年糖尿病心脏植物神经症状出现的阈值。 1 材料和方法 1.1 检查对象 (1)正常对照组:无任何植物神经功能异常的正常人30例(男20人,女10人)。(2)老年糖尿病组:按WHO诊断的老年糖尿病人60例     

心率变异测定在老年糖尿病心脏植物神经障碍中的临床意义

糖尿病心脏植物神经病变是糖尿病最常见且较严重的并发症之一。过去通过对血压的定量间接反映交感神经,立卧位试验检测副交感神经,因此检测心脏植物神经障碍方法可靠程度欠佳。笔者通过分析88例老年糖尿病与正常50例心率变异(HRV)结果,提出心率变异缩小是诊断老年糖尿病早期心脏植物神经障碍的敏感可靠的方法,能早期发现糖尿病心脏植物神经病变,指导临床早期预防严重并发症。     

冠心病与糖尿病患者的心率变异性非线性动力学研究

目的 研究正常人及冠心病单支病变、多支病变、糖尿病伴植物神经性病变患者心率变患者心率变异在非线性动力学上的表现。方法 选用的指标是散点图几项量化指标、测度熵和关联维数。结果 正常人非线笥参数中存在明显的昼夜变化,冠心病患者昼夜变化程度减低,而糖尿病伴植物神经性病变患者昼夜变化规律消失;根据冠心病患者和糖尿病伴植物神经性病变患者的病理生理上都具有植物神经功能紊乱的现象,提示植物神经调节是影响心脏非线性运动的一个重要因素。一些非线性参数可显示正常人、冠心病患者冠脉病变程度及糖尿病伴植物神经病变患者之间的差异。结论 通过特征值提取,心率变异的一些非线性参数,有望为临床工程师提供一种有效的预测冠心病患者预后及检测糖尿病患者植物神经病变程度的指标。     

糖尿病植物神经病变的早期诊断：附64例分析

本文调查了64例糖尿病病人并发植物神经病变的情况,并检测心脏植物神经功能,安静时心率(HR),立位(B-A、B∶C、30∶15)和卧位(S∶L)及深呼吸(HRV)时心平的变化,并与34名健康人对照。结果示糖尿病患者的异常检出率高。心脏植物神经功能试验敏感简单,可重复,有利于糖尿病植物神经病变的早期诊断。     

糖尿病植物神经病变

糖尿病植物神经病变是糖尿病患者常见的并发症之一.据多数文献报告:患病率为17～40%.个别作者报告的患病率多达72%和80%.1980年上海地区在十万人口调查中,新发现糖尿病人150例,其中56%病人患者发生糖尿病植物神经病变.调查结果还发现:糖尿病植物神经病变的发生与性别、病程、病情的严重程度无关.但随年龄增长(高峰见于50～60岁组)和糖尿病控制不良而呈上升趋势.Ewing等报告的73例糖尿病合并植物神经病变患者,随诊19     

高血压对2型糖尿病患者心脏自主神经病变的影响

目的 探讨高血压对2型糖尿病患者心脏自主神经病变的影响。方法 应用短时程心率变异性分析(Heart rate variability，HRV)，对70例糖尿病患者及71例正常对照组测定了HRV，并与有关影响因素作相关分析。结果 糖尿病患者各年龄组的心率变异时域分析指标参数均较对照组降低，HRV与年龄、糖尿病病程、高血压病程呈显著负相关。结论 心脏自主神经病变为2型糖尿病常见的并发症，高血压是加重心脏自主神经病变的因素之一。     

2型糖尿病患者自主神经病变与血糖控制的关系

目的探讨 2型糖尿病自主神经病变及其与血糖控制程度之间的关系。方法对 44例 2型糖尿病患者及 3 0例正常对照者进行自主神经功能 (包括心率差、3 0∶ 1 5比值、卧位反应及 S∶L1 比值、S∶ L2 比值、立位血压 )及血糖测试 ,并将 44例 2型糖尿病患者按血糖控制程度 :好、中等、差分为 3组 ,然后将正常对照组与血糖控制好组进行比较 ,再将 2型糖尿病患者所分成的 3组进行组间比较。结果2型糖尿病患者血糖控制好组的心率差 ,S∶ L1 显著低于正常对照组 ( P<0 .0 5 ) ,2型糖尿病患者血糖控制中等组的心率差 ,3 0∶ 1 5比值显著低于血糖控制好组 ( P<0 .0 5 ) ,2型糖尿病患者血糖控制差组的心率差、3 0∶ 1 5比值、S∶ L1 比值、S∶ L2 比值、立位血压均显著低于血糖控制好组 ( P<0 .0 1 ,P<0 .0 5 )。结论 2型糖尿病血糖控制好的患者也可出现自主神经功能异常 ,而血糖控制好坏与自主神经功能的异常程度有密切关系 ,血糖控制越差自主神经病变越重 ,且 2型糖尿病患者副交感神经较易受损 ,血糖控制对 2型糖尿病患者合并自主神经病变的发生具有重要意义     

88例糖尿病合并高血压患者的心率变异性分析

目的：糖尿病患者心源性猝死率高,其早期变化多表现为心脏植物神经调节失常所致的功能性失调。心率变异性（heartratevariability,HRV）能较好地反映“功能失调”这一特点。本研究拟通过对糖尿病合并高血压患者窦性心搏间标准差（standarddeviationofnormalRRintervals,SDNN）特点的分析,了解这类患者的HRV变化的特征。方法：采集88例糖尿病合并高血压患者临床特征及24小时动态心电图检查资料,分析SDNN与年龄、病程的关系。结果：糖尿病合并高血压患者的SDNN随着病程的延长和年龄的增加而明显降低。结论：本研究反映了糖尿病合并高血压患者心率变异性的规律,对临床早期诊治这类患者的心脏疾患有一定的指导意义。     

糖尿病性植物神经病变的诊断

本文对83例糖尿病人和49例健康者进行心脏植物神经功能测定及胆囊收缩功能和膀胱残余尿检查。结果,糖尿病患者83例中51例(61.4%)有不同程度植物神经损害表现。心脏植物神经功能异常的发生率:静心率12.0%,呼吸差和卧立差分别为73.5%与65.1%、30/15比值55.4%、乏氏指数45.7%,卧立压差49.4%,持续握力试验56.6%;胆囊收缩功能不良(收缩率≤30%)者为56.1%,胆结石与慢性胆囊炎占20.5%;38例(45.78%)有残余尿而对照组无1例阳性。糖尿病组与对照组比较均有显著性差异(P<0.01)。     

正常人及急性心肌梗死患者心率变异频谱分析

目的：运用心率变异频谱分析法研究正常人和急性心肌梗死患者心脏植物神经功能变化。方法：１１４例正常人和２７例ＡＭＩ患者记记录２４ｈ动态心电图，将人武部窦性心率经计算机ＨＲＶ软件处理后使心电信号转换为心率功率频谱。     

A non-invasive approach to cardiac autonomic neuropathy in patients with diabetes mellitus

Summary. The purpose of this study was to obtain information regarding the participation of the sympathetic nervous system in cardiac autonomic neuropathy in patients suffering from diabetes mellitus employing spectral analysis of heart rate variability in the supine and standing posture. Ten insulin-dependent diabetic patients (29 ± 2 years) with a short to moderately long duration of diabetes (11 ± 1 years) and cardiac vagal neuropathy based on measurements of respiratory sinus arrhythmia were compared to 10 healthy volunteers (27 ± 1 years) before and after the administration of atropine and atropine plus propranolol. In diabetic patients the reactivity in total power (ΔTP) from supine to upright position was significantly lower compared to control subjects before and after atropine. There was no significant difference in ΔTP between diabetics and controls after atropine plus propranolol. The magnitude of TP increase is essentially due to the increase of blood pressure related heart rate fluctuations (ΔMF) from lying to standing and dependent on β-adrenergical efferent activity to the heart. In diabetic patients as well as in normal subjects under the influence of atropine plus propranolol the ΔMF power was significantly lower compared to the un-medicated control and atropine group. There was no significant difference between diabetics and controls after combined autonomic blockade. It was concluded that ΔMF heart rate spectral power could serve as an indirect, non-invasive, quantitative and sensitive marker of early cardiac sympathetic damage.     

The prevalence of autonomic neuropathy in insulin-dependent diabetes mellitus: a controlled study based on heart rate variability

Autonomic function was investigated by tests of heart rate variation in 506 unselected insulin-dependent diabetics aged 12 to 85 years. Heart rate variability was measured by a computerised technique during rest and in response to a single deep breath, the Valsalva manoeuvre and standing. Changes in heart rate were compared with age-related normal ranges derived from 310 non-diabetic control subjects aged 18 to 87 years. Heart rate responses were found to be below the 5th centile control value in 13 to 23 per cent of diabetics. Impaired heart rate variability occurred more frequently in response to a single deep breath than to the other procedures. Results from all four procedures were combined in each subject to give an 'autonomic score', varying from 0 to 4. This score was greater than 1 in only five of 310 (1.6 per cent) non-diabetic control subjects. A score of 2 or more was therefore defined as abnormal and indicative of cardiac autonomic denervation. Abnormal autonomic scores were found in 84 diabetics (16.6 per cent). In diabetic subjects the autonomic score correlated most closely with heart rate variability at rest and in response to a single deep breath. Abnormal autonomic scores correlated significantly with duration of diabetes (p less than 0.0001) but not with age (p = 0.06). The frequency of abnormal autonomic scores was greatest in diabetics aged 40 to 49 years (24.5 per cent) and those with diabetes of 20 or more years duration (30.7 per cent).     

The Prevalence of Autonomic Neuropathy in Insulin-dependent Diabetes Mellitus: A Controlled Study Based on Heart Rate Variability

Autonomic function was investigated by tests of heart rate variationin 506 unselected insulindependent diabetics aged 12 to 85 years.Heart rate variability was measured by a computerised techniqueduring rest and in response to a single deep breath, the Valsalvamanoeuvre and standing. Changes in heart rate were comparedwith age-related normal ranges derived from 310 non-diabeticcontrol subjects aged 18 to 87 years. Heart rate responses werefound to be below the 5th centile control value in 13 to 23per cent of diabetics. Impaired heart rate variability occurredmore frequently in response to a single deep breath than tothe other procedures. Results from all four procedures were combined in each subjectto give an ‘autonomic score’, varying from 0 to4. This score was greater than 1 in only five of 310 (1.6 percent) non-diabetic control subjects. A score of 2 or more wastherefore defined as abnormal and indicative of cardiac autonomicdenervation. Abnormal autonomic scores were found in 84 diabetics(16.6 per cent). In diabetic subjects the autonomic score correlatedmost closely with heart rate variability at rest and in responseto a single deep breath. Abnormal autonomic scores correlatedsignificantly with duration of diabetes (p<0.0001) but notwith age (p=0.06). The frequency of abnormal autonomic scoreswas greatest in diabetics aged 40 to 49 years (24.5 per cent)and those with diabetes of 20 or more years duration (30.7 percent).     

Effect of pregnancy on autonomic nervous function and heart rate in diabetic and nondiabetic women

Supine and standing heart rate and heart rate responses to deep breathing and standing up (the 30-to-15 ratio), indices of autonomic nervous function, were measured during each trimester and postpartum in 25 women with insulin-dependent diabetes and 10 nondiabetic women. The groups did not differ with respect to autonomic function in the basal state (postpartum), and the heart rate response to deep breathing diminished progressively in both groups during pregnancy, although the change tended to be less pronounced in the diabetic women. The 30-to-15 ratio did not alter significantly during pregnancy. The diabetic women had a higher supine heart rate than the healthy women in the basal state, but the pregnancy-induced increase in heart rate was less in the diabetic women. Thus, the reversible diminution of heart rate response to deep breathing during pregnancy is a physiological finding and does not denote development of autonomic nervous dysfunction. Second, the increase in heart rate, a primary cardiovascular adjustment to pregnancy, seems to be blunted in diabetic women.     

2型糖尿病患者心率变异性的改变及卡托普利对其影响

目的探讨2型糖尿病患者心率变异性(HRV)改变的特征及卡托普利对其影响。方法110例2型糖尿病患者分剐进行24h动态心电图检查并与50例正常人进行比较。110例2型糖尿病患者随机分为常规治疗组和卡托普利组；卡托普利组在常规治疗基础上加卡托普利治疗，观察治疗后1、3和6个月后HRV的变化。结果2型糖尿病患者HRV各项指标与正常对照组相比具有显著性差异。卡托普利组治疗3～6个月后，心率变异频域和时域各项指标均有明显改善。结论2型糖尿病患者HRV降低，自主神经功能受损；卡托普利可改善其自主神经功能。     

Autonomic nerve function in children and adolescents with insulin-dependent diabetes mellitus

Autonomic nerve function was assessed in 67 insulin-dependent diabetic children and adolescents and in 30 control subjects of the same age. The heart rate and blood pressure reactions to a deep breathing test (E/I ratio) and a tilt table test (acceleration and brake indices) were used. The E/I ratio, 1·54 +0·21, and the acceleration index, 25 ± 7·7, in the diabetic children were not significantly different from those of the control children, 1·51 ± 0·16 and 24 ± 7·5, respectively. Neither was any difference observed between the mean brake index values; 24·3 ± 14·6 vs 23·5 ± 7·5. However, the variance of the brake index in diabetic children was significantly higher than in control children (P< 0·005). The brake index was negatively correlated to age in the healthy control children (r= -0·48, P <0·1). The acceleration index, but not the E/I ratio, also tended to be age related (r= -0·32, P<0·01 NS). No correlation was observed between sex, glycaemic control or duration of diabetes and the autonomic nerve function. Neither were severe hypoglycaemic episodes in diabetic children related to the autonomic nerve function. It is concluded that autonomic neuropathy is uncommon in diabetic children and adolescents and that age-related index values should be used when autonomic nerve function is evaluated in children of different ages.     

Left ventricular systolic and diastolic functional abnormalities in asymptomatic patients with non-insulin-dependent diabetes mellitus.

The aim of this study was to evaluate the relations between left ventricular (LV) functional abnormalities, microangiopathy, and autonomic dysfunction in patients with non-insulin-dependent diabetes mellitus (NIDDM). We studied 66 normotensive patients with NIDDM of > or =4 years' duration (age, 51 +/- 4.5 years; 35 men) and no clinical evidence of cardiac disease. Twenty-one healthy subjects matched for age and sex served as a control group. Echocardiography and Doppler studies were performed to assess LV systolic and diastolic function. Microangiopathy was assessed by fundus examination. Autonomic function was assessed by standing blood pressure and heart rate response to Valsalva maneuver. Patients with NIDDM had a lower ejection fraction (58% +/- 11% versus 66% +/- 4%, P <.0001), E-F deceleration slope (382 +/- 75 versus 427 +/- 31 cm/s(2), P <.05), and E velocity (55 +/- 11 vs. 58 +/- 6 cm/s, P =.02) of the mitral diastolic flow, compared with control subjects, respectively. Patients with ejection fraction <50% had a higher prevalence of retinopathy (65% versus 29%, P <.005), abnormal blood pressure response to standing (53% versus 8%, P <.0005), and proteinuria (65% versus 27%, P =.006). An inverse correlation was found between the duration of diabetes and both the ejection fraction (r = -0.53, P <.05) and E/A ratio (r = -0.4, P <.005). E/A ratio <1 was associated with a higher prevalence of retinopathy (49% versus 20%, P =.01) and abnormal blood pressure response to standing (29% versus 4%, P <.005). Patients with NIDDM and no symptoms of cardiovascular disease have a reduced LV systolic and diastolic function as compared with healthy subjects. LV systolic and diastolic abnormalities are correlated with the duration of diabetes and with other diabetic microangiopathies such as diabetic retinopathy and neuropathy.     

Age-related diminution of the cardiovascular autonomic responses: diagnostic problems in the elderly

Summary. To study the usefulness of standard cardiovascular autonomic reflex tests in the elderly, 224 healthy controls and 49 aged diabetic patients were examined. Based on the data obtained from healthy controls, age-related reference values for several autonomic indices were calculated and their usefulness was tested with aged diabetic patients. It was found (1) that in elderly subjects (aged 50 years) the indices based on heart rate differences are more suitable for the assessment the autonomic parasympathetic control than indices based on R/R interval ratios, (2) that the tests (and indices) of choice in the elderly subjects are the Valsalva manoeuvre (Valsalva difference and tachycardia difference) and the active orthostatic test (Max-Rest difference, immediate and later change in systolic blood pressure), (3) that the usefulness of the deep breathing test is limited in the elderly, (4) that such commonly used indices as the Valsalva ratio and the Max/Min ratio in orthostatic test are not useful in the elderly, and (5) that the isometric handgrip test is of little use in the assessment of the autonomic function in the elderly. In conclusion, standard cardiovascular autonomic reflex tests can be used in the assessment of autonomic function to some extent also in the elderly subjects. However, one must bear in mind the limitations in their applicability in that age group.,     

Cough test to assess cardiovascular autonomic reflexes in diabetes

Coughing induces cardioacceleratory responses under cholinergic control. The Cough Test (CT), a standardized test that uses a series of coughs with electrocardiographic monitoring, was used to assess the functional integrity of cardiovascular autonomic nerves. In 224 control subjects and 235 diabetic patients, heart-rate (HR) responses were compared with four established tests: lying to standing (LS), standing to lying (SL), deep breathing (DB), and Valsalva maneuver (VM). In control subjects, HR responses declined significantly with age in a curvilinear pattern. Log-transformed indices were used to estimate percentiles. The CT-HR responses were reproducible and significantly associated with other HR-response tests. Sixty-nine (29%) diabetic patients had an abnormal value less than or equal to 1st percentile, whereas only 2 control subjects had such an abnormality. Among diabetic patients, age and duration of diabetes exerted a significant negative influence. With the use of the criteria of two abnormal or one abnormal and two borderline tests (among CT, LS, SL, DB, or VM) as a minimal criteria for cardiovascular autonomic neuropathy, CT and LS had the least overlap between the control and diabetic populations and were significantly better than SL or VM (P less than 0.005 for CT, P less than 0.01 for LS). They were not different from DB. We found the CT to be simple to perform, reproducible, and useful for the assessment of cardiovascular autonomic reflexes.     

Beat-to-beat blood pressure response in asymptomatic IDDM subjects

Nine insulin-dependent diabetic (IDDM) patients (aged 25-37 yr) with no symptoms of autonomic neuropathy and 15 healthy control subjects (aged 26-39 yr) were studied at rest and during tests of Valsalva maneuver, deep breathing, cold pressor, and postural change from sitting to standing. Continuous (beat-to-beat) measures were taken of heart rate, systolic blood pressure, diastolic blood pressure, and skin conductance. The diabetic patients were differentiated from the control group by the following: less variability in diastolic blood pressure during deep breathing, failure to exhibit diastolic blood pressure decreases during recovery from a cold pressor stimulus, a flatter blood pressure response pattern when changing from sitting to standing, and a smaller standing ratio (maximum/minimum) for R-R interval. Among the patients, age was negatively correlated with systolic and diastolic standing ratios and diastolic blood pressure variability during deep breathing. By use of the tracking cuff, a method of continuously recording blood pressure noninvasively, we have been able to assess subtle blood pressure changes, thereby revealing signs of sympathetic dysfunction in a group of relatively young diabetic patients with no symptoms of neuropathy. The tracking-cuff method of recording blood pressure has potential in further research on autonomic functioning in diabetic patients.