CAJ | 학술논문

目的比较老年原发性高血压病( EH)患者及高血压合并糖尿病(EH+T2DM)患者的心率减速力(DC)的变化以及其与胰岛素抵抗( IR)的相关性。方法将64例老年EH患者根据葡萄糖耐量试验结果分为高血压合并糖耐量正常组(EH+NGT)28例、高血压合并糖耐量异常组(EH+IGT)18例和高血压合并2型糖尿病组(EH+T2DM)18例,再进行24 h 12导联同步动态心电图检测和超声心动图检查。应用相应的分析软件对动态心电图检查结果进行分析,比较不同组DC值变化、心率变异性的总标准差( SDNN)、左室射血分数( LVEF)以及代谢指标。结果 EH + T2DM 组 DC、SDNN明显低于 EH+IGT和 EH+NGT组( P <0.05, P <0.01),EH + T2DM 组 LVEF 明显低于 EH + NGT 组( P <0.05),胰岛素抵抗指数(HOMA-IR)、空腹血糖(FBG)、餐后2小时血糖(2hPG)明显高于EH+IGT和EH+NGT组( P<0.01)。在EH+IGT和EH+T2DM组内,HOMA-IR与DC、LVEF、SDNN、FBG、2hPG呈负相关( r=-0.587,P<0.01；r=-0.266,P<0.05；r=-0.808,P<0.05；r=-0.306,P<0.05；r=-0.451,P<0.01),与胆固醇呈正相关(r=0.503, P<0.05)。结论在老年EH人群中,糖代谢紊乱影响DC,可能为IR加重自主神经功能损害所致。
목적비교노년원발성고혈압병( EH)환자급고혈압합병당뇨병(EH+T2DM)환자적심솔감속력(DC)적변화이급기여이도소저항( IR)적상관성。방법장64례노년EH환자근거포도당내량시험결과분위고혈압합병당내량정상조(EH+NGT)28례、고혈압합병당내량이상조(EH+IGT)18례화고혈압합병2형당뇨병조(EH+T2DM)18례,재진행24 h 12도련동보동태심전도검측화초성심동도검사。응용상응적분석연건대동태심전도검사결과진행분석,비교불동조DC치변화、심솔변이성적총표준차( SDNN)、좌실사혈분수( LVEF)이급대사지표。결과 EH + T2DM 조 DC、SDNN명현저우 EH+IGT화 EH+NGT조( P <0.05, P <0.01),EH + T2DM 조 LVEF 명현저우 EH + NGT 조( P <0.05),이도소저항지수(HOMA-IR)、공복혈당(FBG)、찬후2소시혈당(2hPG)명현고우EH+IGT화EH+NGT조( P<0.01)。재EH+IGT화EH+T2DM조내,HOMA-IR여DC、LVEF、SDNN、FBG、2hPG정부상관( r=-0.587,P<0.01；r=-0.266,P<0.05；r=-0.808,P<0.05；r=-0.306,P<0.05；r=-0.451,P<0.01),여담고순정정상관(r=0.503, P<0.05)。결론재노년EH인군중,당대사문란영향DC,가능위IR가중자주신경공능손해소치。
Objective To investigate the changes of deceleration capacity of heart rate ( DC ) in patients suffering from essential hypertension with different glucose tolerance and to explore the correlation between DC and insulin resistance. Methods Sixty-four cases of essential hypertension combined with different glucose tolerance were en-rolled in this study. All patients were monitored with 12-lead 24 h hoter. DC and standard deviation of normal to normal intervals( SDDN) and left ventricular ejection fraction( LVEF) and metablic index were calculated. Results DC and SDDN in essential hypertension group decreased significantly(P<0.05, P<0.01) with the increasing of blood glucose, and LVEF decreased significantly ( P <0.05 ) with the normal glucose tolerance. Homeostasis model assessment for insulin resistance(HOMA-IR),fasting blood glucose(FBG),2 hour plasma glucose(2hPG) group increased significantly( P<0.01 ) with the increasing of blood glucose. HOMA-IR was relevant to the DC and LVEF and SDNN and FBG and 2hPG (r= -0.587,P<0.01;r= -0.266,P<0.05;r= -0.808,P<0.05;r= -0.306,P<0.05;r= -0.451,P<0.01) negatively,total cholesterol (r=0.503,P<0. 05) positively. Con-clusion In elderly hypertensive patients,glucose metabolism disorders may influence the DC, and the autonomic nervous function is damaged with the insulin resistance.