基于Ewing试验的心率变异性分析对2型糖尿病患者心脏自主神经病变诊断的临床价值研究

目的结合Ewing试验和心率变异性(HRV)分析两种糖尿病心脏自主神经病变(DCAN)诊断方法,探讨基于Ewing试验的HRV分析对DCAN的临床价值。方法选取2012年2月至2013年1月于广东省人民医院内分泌科就诊的T2DM患者47例(T2DM组),及同期体检健康人群19名为正常对照(NC)组。所有受试者在Ewing试验过程中,予心脏搏动法监测HRV。分析静息状态及Ewing试验各项目期间HRV各参数变化,尝试探索基于Ewing试验的HRV诊断模式并评价其临床实用价值。结果以Ewing试验为诊断标准,T2DM组DCAN患病率为55.3%。随机纳入70%T2DM患者(预测组)的HRV指标得到Ewing-HRV诊断组合,包括握力试验时高频功率(HF)、静息状态时低频功率(LF)/HF、Valsalva动作时LF,该模式在其余30%T2DM患者(验证组)中,与Ewing试验诊断方法的符合性:Kappa=0.857,P=0.001,敏感性为100%,特异性为87.5%,阳性预测值为85.7%,阴性预测值为100%。结论基于Ewing的HRV诊断组合(Ewing-HRV法)与经典的Ewing试验的诊断效率高度吻合且该方法无创、受主观因素影响小、简单易行,在进一步探讨和分析的基础上可用于DCAN筛查。

Clinical value of the Ewing tests based HRV in diabetic cardiac autonomic neuropathy diagnosis

Objective To evaluate the strategy of Ewing tests and HRV in diabetic cardiac autonomic neuropathy(DCAN)diagnosis,and to explore the clinical value of Ewing-HRV method in DCAN diagnosis.Methods A total of 47 patients with T2DM(T2DM group)in outpatients clinic or admitted in the Endocrinology Department in Guangdong Provincial People’s Hospital were enrolled in this study from February 2012 to January 2013.During the same time,19 healthy subjects were selected as control group(NC group).All participants were assessed HRV parameters at rest state and during Ewing tests.The index changes at rest state and during Ewing tests were evaluated,and the HRV diagnostic model based on Ewing test was explored.Results The prevalence of DCAN was 55.3%using Ewing test as diagnostic criteria.Ewing-HRV mode on the basic of 70%T2DM patients’HRV data(training group),including HF in handgrip test,LF/HF in rest state,LF in Valsalva test,matched well with Ewing tests in 30%T2DM patients(validation group).Kappa was 0.857,with sensitivity of 100%,specificity of 87.5%,positive predictive value of 85.7%and negative predictive value of 100%.Conclusion Diagnostic method of Ewing-HRV matched well with traditional Ewing tests,and it had the advantage of noninvasive,less affected by subjective factors and easy to operate.On the basis of further discussion and analysis,Ewing-HRV may be used in the screening of DCAN.