心率变异时域分析对糖尿病患者自主神经功能的评价

采用２４小时动态心电图对８２例糖尿病患者进行心率变异（ＨＲＶ）和心率（ＨＲ）检测。８２例分为五组：Ａ组（无血管合并症）３０例、Ｂ组（合并大血管病变）１１例、Ｃ组（合并小血管病变）１２例、Ｄ组（同时合并大、小血管病变）１９例和Ｅ组（心肾功能不全）１０例，并设正常对照组。结果：糖尿病各组ＨＲＶ显著降低，Ａ组仅２４ｈ内全部正常ＲＲ间期标准差（ＳＤＮＮ，１０４．２０±２９．１９ｍｓ）和２４ｈ内５ｍｉｎ节段平均正常ＲＲ间期的标准差（ＳＤＡＮＮｉｎｄｅｘ，９３．７３±２７．５８ｍｓ）降低（对照组分别为１２７．５２±３８．５７ｍｓ和１１６．１９±３５．７０ｍｓ），Ｐ均＜０．０１；ＨＲ异常主要表现为夜间平均ＨＲ增快，白昼平均ＨＲ仅Ｅ组（８６．７６±１１．３６ｂｐｍ）高于对照组（７６．３８±９．４０ｂｐｍ），Ｐ＜０．０１。表明糖尿病患者存在自主神经受累，白昼心率增快可能是病情严重的征兆。

Time Domain Analysis of Heart Rate Variability to Evaluate Autonomic Neuropathy of Diabetic Patients

The parameters of heart rate variability (HRV) and heart rate (HR) were determined by 24 hour ambulatory electrocardiography in 54 normal subjects as control and 82 diabetic patients,which including group A (30 cases without angiopathy),group B (11 cases with macroangiopathy),group C (12 cases with microangiopathy),group D (19 cases with both macro and micro angiopathy) and group E (10 cases with heart and renal dysfunction).Results:The HRV was significantly reduced in 82 diabetic patients.Compared with the control,only SDNN (104.20±29.19 ms vs 127.52±38.57 ms,P<0.01) and SDANNindex (93.73±27.58 ms vs 116.19±35.70 ms,P<0.01) were decreased in group A.However,in other groups,abnormality of HR was mainly presented as increase in mean nightime HR besides SDNN and SDANNindex,and in group E the mean daytime HR increased compared with the control (86.76±11.36 bpm vs 76.38±9.40 bpm, P<0.01).Conclusion:There is autonomic neuropathy in diabetic patients.SDNN and SDANNindex are valuable parameters in the time domain indexes of HRV.Increase of daytime HR may be a symbol of exacerbation of the condition.