糖尿病患者自主神经病变与24小时动态血压变化关系探讨

目的探讨糖尿病（DM）患者自主神经病变与24 h动态血压变化关系。方法选择2型DM患者289例进行24 h动态心电监测,24 h动态血压监测根据心率变异性（HRV）时域指标即正常窦性R-R间期的标准差（SDNN）,按其危险水平划分为正常组、低危险组、中高危险组。比较各组最高收缩压（SBP）、舒张压（DBP）、最低收缩压（SBP）、舒张压（DBP）及血压负荷值。结果DM HRV中高危险组和低危险组最高和最低血压均高于正常组;DM HRV中高危险组最高和最低血压均高于低危险组,差异有统计学意义;DM HRV中高危险组和低危险组血压负荷值均高于正常组,DM HRV中高危险组夜间血压负荷值高于低危险组,差异有统计学意义,而白天血压负荷值在两者间无统计学意义。结论DM HRV中高危险组患者夜间血压升高明显,24 h血压波动节律异常,而DM HRV低危险组患者白天血压升高明显,显示DM自主神经病变不同状况与24 h动态血压变化关系密切。

RELATIONSHIP BETWEEN AUTONOMIC NERVOUS PATHOLOGICAL CHANGES AND 24-HOUR DYNAMIC BLOOD PRESSURE CHANGE IN PATIENTS WITH DIABETES MELLITUS

Objective To research into the relation between autonomic nervous pathological changes and 24-hour dynamic blood pressure change in patients with diabetes mellitus.Methods To select 289 patients with type II diabetes mellitus to have 24-hour dynamic electrocardiographic monitoring and 24-hour dynamic blood pressure monitoring,and divide the patients into normal group,low risk group and medium ＆ high risk group according to HRV time-domain indicator,that is,SDNN and its risk level.To compare highest systolic blood pressure,diastolic blood pressure,lowest systolic blood pressure,diastolic blood pressure and blood pressure load among each group.Results Lowest and highest blood pressures of medium ＆ high risk group and low risk group were both higher than that of normal group among DM HRV;Lowest and highest blood pressures of medium ＆ high risk group were both higher than that of low risk group among DM HRV;The disparity showed statistics significance.Blood pressure loads of medium ＆ high risk group and low risk group are both higher than that of normal group among DM HRV;Blood pressure load of medium ＆ high risk group during nighttime is higher than that of low risk group among DM HRV,the disparity has significance to statistics.However,the blood pressure load during daytime was between them,which showed no significance to statistics.Conclusion HRV in patients with diabetes mellitus in medium ＆ high risk group,the blood pressure increases significantly during nighttime,the fluctuation rhythm of 24-hour blood pressure is abnormal,however,the patients in low risk group,the blood pressure increases significantly during daytime,which shows that the different situations of autonomic nervous pathological changes of diabetes mellitus patients has close relation with 24-hour dynamic blood pressure changes.