2型糖尿病合并冠心病患者心率变导与QT离散度的关系

目的　探讨 2型糖尿病 (T2DM )合并冠心病 (CHD)的心率变异 (HRV)与QT离散度 (QTd)的关系。方法　选择 2 0 0 1- 0 2～ 2 0 0 4 - 0 2东莞市人民医院 2型糖尿病 33例 (B组 )、2型糖尿病合并冠心病 30例 (A组 )患者 ,同时选择正常人 2 1例做对照 (C组 ) ,分别做 2 4h动态心电图 ,经电脑系统分析得出HRV时域和频域分析参数 ,做常规 12导联同步心电图 ,测定QT间期及QTd。结果　 (1)A组的HRV各项参数均低于B组和C组 (P<0 0 1) ,QTd均大于B组和C组 (P <0 0 5 ,P <0 0 1) ;B组的HRV各项参数亦均低于C组 (P <0 0 5 ) ,QTd亦均大于C组 (P <0 0 5 )。 (2 )A组和B组的QTd与SDNN、SDANN、SDNN index均存在着负相关 (P <0 0 5 )。结论　T2DM合并冠心病者心脏自主神经损害较单纯T2DM者重 ,前者迷走神经受损较后者更重。对T2DM及T2DM合并CHD患者常规 2 4h动态心电图检查 ,测量QTd是有益的 ,以便早期发现高危患者。

Relationship between heart rate variability and QT dispersion in patients with type 2 diabetes mellitus complicated with coronary heart disease

Objective To research into the relationship between heart rate variability (HRV) and QT dispersion(QTd) in patients with type 2 diabetes mellitus(T2DM) complicated with coronary heart disease(CHD).Methods In the research 30 patients with type 2 diabetes mellitus complicated with CHD were classified as group A,33 patients with T2DM as group B and 21 normal healthy persons as controlgroup,group C.24-hour time domain and 24-hour frequency domain parameters of HRV were recorded by holter ECG and analysed through computer.A standard 12-lead synchronous electrocardiogram was used to measure QT interval and QTd.Results (1)The research showed that all parameters of HRV in group A were less than those in group B and group C (P<0.01),and the average of QTd in group A was more than that in group B and group C (P<0.05,P<0.01).The parameters of HRV in group B were less than those in group C (P<0.05),and the average of QTd in group B was more than that in group C (P<0.05).(2)There were statistical negative correlations in QTd and SDNN and SDANN and SSDNN-index between group A and group B(P<0.05).Conclusion The cardiovascular autonomic nerves damage in patients with T2DM complicated with CHD is more than that in T2DM.The pneumogastric nerves are more severely damaged in the former than in the latter.To check HRV and measure QTd in patients with T2DM complicated with CHD are beneficial to discover the high risky patients earlier.