2型糖尿病心脏自主神经病变临床特征和危险因素分析

目的探讨2型糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,DCAN)的临床特征及相关危险因素。方法纳入2012年2月至2013年1月在广东省人民医院内分泌科就诊的2型糖尿病患者47例(按1999年世界卫生组织建议的糖尿病诊断标准),所有2型糖尿病患者进行葡萄糖耐量试验(OGTT)、胰岛素释放试验、血脂等分析,并以Ewing试验作为诊断DCAN的标准,对DCAN的患病情况、临床特征及可能的主要危险因素进行分析。同时,招募糖耐量正常者19例设为正常对照组。结果以Ewing试验为标准诊断心脏自主神经病变(cardiac autonomic neuropathy,CAN),正常对照组CAN的患病率仅为5.3%(1/19),2型糖尿病组为55.3%(26/47),两组比较差异有统计学意义(P=0.001)。2型糖尿病组中病程≤5年患者的DCAN患病率为45.2%(14/31),>5年患者为75.0%(12/16),两者比较差异有统计学意义(P=0.051)。2型糖尿病组中DCAN患者心率、收缩压、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、尿酸与正常对照组患者比较,差异有统计学意义(P<0.05)。静息心率>80次/min、收缩压>140 mm Hg(1 mm Hg=0.133 kPa)、空腹胰岛素>100 pmol/L、胰岛素抵抗指数>5.3或胰岛素分泌指数>102.65、尿酸>350μmol/L的患者的DCAN患病率均较正明显增加,均差异有统计学意义(P<0.05)。Logistic回归分析显示,糖化血红蛋白(HbA1c)(OR=11.788)、胰岛素抵抗指数(OR=17.211)、尿酸(OR=5.757)是DCAN的主要独立危险因素。结论 2型糖尿病患者是CAN的高危人群;糖化血红蛋白、胰岛素抵抗指数、尿酸是DCAN的主要独立危险因素。

Clinical characteristics and risk factors of type 2 diabetic cardiac autonomic neuropathy

Objectives To explore the clinical characteristics and risk factors of cardiac autonomic neuropathy （CAN） in type 2 diabetes mellitus （T2DM）. Methods A total of 47 patients with T2DM in Department of Endocrinology in Guangdong General Hospital from February 2012 to January 2013 were enrolled. Meanwhile, 19 volunteers were enrolled as control group. All patients received oral glucose tolerance test （OGTY）, insulin release and blood fat determination, etc. Diabetic cardiac autonomic neuropathy （DCAN） was diagnosed by Ewing experiment. Clinical characteristics and risk factors of DCAN were analyzed. Results On the basis of Ewing experiment to diagnose DCAN, prevalence rate was 5.3% （1/19） in control group and 55.3% （26/47） in T2DM group （P=0.001）. Among patients with T2DM diagnosed as CAN, 45.2% （14/31） distributed to those with a disease duration of less than 5 years, and 75% （12/16） to those more than 5 years （P=0.051）. Resting heart rate, systolic blood pressure, fasting insulin, homeostasis model assessment insulin resistance （HOMA-IR）, homeostasis model assessment-~ （HOMA-3） and uric acid of patines with DCAN in T2DM group were significantly different, compared with those in control group （P〈0.05）. DCAN prevalence rate significantly increased in patients with T2DM whose resting heart rate 〉 80 beats/min, systolic blood pressure 〉 140 mm Hg （1 mm Hg=0.133 kPa）, fasting insulin 〉 100 pmol/L, HOMA-IR 〉 5.3, HOMA-5 〉 102.65 or uric acid 〉 350 Ixmol/L （P〈0.05）. Among the indices, hemoglobin Ale （HbAlc） （0R=11.788）, HOMA-IR （0R=17.211） and uric acid （0R=5.757） were risk factors of DCAN by Logistic analysis. Conclusions Patients with T2DM are the high risk group of CAN. HbAlc, HOMA-IR and uric acid are the risk factors of DCAN.