心率恢复法检测2型糖尿病患者心脏自主神经病变

W. Hassan, E. Hafez, E. Zaki, G. Ahmad
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摘要

背景:心脏自主神经病变是糖尿病最隐匿的并发症之一。它可以通过心率恢复异常来检测,心率恢复异常的定义是在分级运动压力测试后的前几分钟内心率下降。目的应用心率恢复法检测2型糖尿病患者的心脏自主神经病变。患者与方法本研究纳入45例个体,病例组为30例糖尿病患者,对照组为15例健康人。所有参与者均进行病史记录、临床检查、实验室检查(FBS、PPBS、HbA1c、肾功能和肝酶检查)、经胸超声心动图综合检查、24 h动态心电图监测和运动心电图试验,评估心率恢复情况。结果30例糖尿病患者(男性7例,女性23例,平均年龄40±3.5岁)和15例健康人(男性4例,女性11例,平均年龄36±5.8岁)参加了本研究。病例组FBS、PPBS、HbA1c、血清肌酐较对照组显著升高。与对照组相比,患者在24 h动态心电图监测中PNN50、SDNN、LF和HF显著降低,第1分钟和第2分钟心率恢复明显延迟。血糖控制和糖尿病病程是异常心率恢复的最重要预测因子。结论运动心电图心率恢复试验是一种简便、成本低、应用广泛的检测心脏自主神经病变的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Detection of cardiac autonomic neuropathy in type II diabetic patients using heart rate recovery
Background Cardiac autonomic neuropathy is one of the most insidious complications of diabetes mellitus. It can be detected by abnormality in heart rate recovery, which is defined as decline in heart rate within the first few minutes following a graded exercise stress test. Aim To detect cardiac autonomic neuropathy in type II diabetic patients using heart rate recovery. Patients and methods This study included 45 individuals, 30 diabetic patients in case group and 15 healthy individuals as a control. All participants underwent history taking, clinical examination, laboratory investigations (FBS, PPBS, HbA1c, kidney function test and liver enzymes), comprehensive transthoracic echocardiographic examination, 24 h Holter monitor and exercise ECG test to assess heart rate recovery. Results 30 diabetic patients (7 male and 23 females, with mean age 40±3.5 years) and 15 healthy individuals (4 males and 11 females with mean age 36±5.8 years) participated in this study. Cases group had significant increase in FBS, PPBS, HbA1c and serum creatinine compared to control group. Patients had significant decrease in PNN50, SDNN, LF and HF in the 24 h Holter monitoring as well as significant delay in heart rate recovery at 1st and 2nd minutes compared to control group. Glycemic control and duration of diabetes were the most predictors to abnormal heart rate recovery. Conclusion Heart rate recovery derived from exercise ECG test could be considered as an easy, low cost and widely available tool for detection of cardiac autonomic neuropathy.
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