糖尿病患者室性心动过速与自主神经病变的关系

目的通过观察糖尿病合并室性心动过速患者的校正QT间期（QTc）、校正的QT间期离散度（QTcd）与心率变异性变化,探讨室性心动过速与自主神经病变的关系。方法选择2011年1月~2014年5月于深圳市第四人民医院收治的2型糖尿病患者85例（糖尿病组）,根据动态心电图检查结果分为糖尿病合并室性心动过速组（糖尿病室速组,31例）和普通糖尿病组（54例）,另选择同期健康者49例作为正常对照组。所有研究对象均进行QTc、QTcd测定与心率变异性分析,并将所有糖尿病患者的QTc、QTcd分别与心率变异性及心率（HR）进行相关性分析。结果糖尿病室速组患者的心率、QTc、QTcd的值与普通糖尿病组、正常对照组比较,差异均有统计学意义（P〈0.05）;而普通糖尿病组与健康对照组的各项指标的比较,差异无统计学意义（P〉0.05）。糖尿病组进行QTc、QTcd与心率变异性各指标的相关性分析结果显示：QTc、QTcd与心率呈正相关（r=0.870、0.810,P〈0.05）,与24 h内相邻正常窦性心率R-R间期的标准差（SDNN）（r=-0.800、-0.818,P〈0.05）、每5分钟正常R-R间期平均值标准差（SDANN）（r=-0.794、-0.901,P〈0.05）及每5分钟正常R-R间期标准差的平均值（SDNN-Index）（r=-0.825、-0.735,P〈0.05）呈负相关。比较糖尿病患者室性心动过速的发生率可见,糖尿病患者随SDNN的降低,室性心动过速的发生率不断升高,且SDNN〈50 ms的患者室性心动过速的发生率与100 ms≤SDNN≤50 ms及SDNN〉100 ms的比较,差异有统计学意义（P〈0.05）。结论糖尿病合并室速患者自主神经功能明显损害,糖尿病患者行QTc、QTcd与心率变异性监测对防治心脏自主神经病变有重要意义。

Relationship between ventricular tachycardia and autonomic neuropathy in diabetic patients

Objective By observing the changes of QTc QTcd and heart rate variability in diabetic patients with ventricular tachycardia（VT）, to investigate the relationship between the VT and autonomic neuropathy. Methods From January 2011 to May 2014, in the Fourth People＇s Hospital of Shenzhen City, 85 patients with 2 type diabetes were selected, and divided into diabetes with VT group（31 cases） and common diabetic group（54 cases）, according to the results of dynamic ECG examination. At the same time, 49 healthy persons were selected as healthy control group. The QTc, QTcd and heart rate variability were determined and analyzed. In all diabetic patients, correlation analysis between QTc, QTcd and heart rate variability and between QTc, QTcd and heart rate（HR） were performed. Results The HR, QTc, QTcd of diabetes with VT group were comnpared with those of common diabetic group and healthy control group, the differences were statistically significant（P 〈0.05）. The correlation analysis results showed QTc and QTcd were positively correlated with HR（r = 0.870, 0.810, P 〈0.05）; negatively correlated with SDNN（r =-0.800,-0.818, P 〈0.05）, SDANN（r =-0.794,-0.901, P 〈0.05） and SDNN-Index（r =-0.825,-0.735, P〈 0.05）. The results of comparison of the incidence of ventricular tachycardia in patients with diabetes showed, with SDNN decreasing the incidence of VT was continuously increasing in patients with diabetes, the occurrence rate of VT in patients with SDNN50 ms were compared with that of 100 ms≤SDNN≤50 ms and SDNN100 ms, the differences were statistically significant（P〈 0.05）. Conclusion There is obvious damage of autonomic nervous function in diabetic patients with ventricular tachycardia, and monitoring on QTc, QTcd and heart rate variability of diabetic patients has important significance for prevention and treatment of cardiac autonomic neuropathy.