CAJ | 학술논문

目的：探讨心率变异性与外周神经、下肢动脉病变、视网膜病变及肾脏病变等糖尿病慢性并发症的关系。方法多学科联合门诊、预约患者集中完成眼底、肾脏、下肢动脉病变等并发症筛查；采用美国GE Marquette 公司生产的动态心电图机及三通道模拟 V5、V1、avF导联记录器，记录心率变异性时域、频域指标。结果糖尿病组（96例）与正常对照组（136例）比较，糖尿病患者心率变异性频域及时域指标均降低（ P ＜0.05）；合并视网膜病变的糖尿病患者，其全部正常窦性心搏间期的标准差（ SDNN）、5 min时间心搏间期均值的标准差（ SDANN）、全程相邻NN间期之差的均方差值（ RMSSD）、全部NN间期之差＞50 ms的心搏数，除以总的NN间期个数，乘以100（PNN50）均低于正常眼底的糖尿病患者（ P ＜0.01， P ＜0.05）；合并肾脏病变患者的心率变异性指标除低频/高频（ LF/HF）、平均窦性NN间期（ MNN）外，其他指标均明显低于非肾病组糖尿病患者（ P ＜0.01， P ＜0.05）；合并下肢动脉病变与无病变的糖尿病患者比较，心率变异性指标差异无统计学意义（ P ＞0.05）。结论糖尿病患者长期高血糖加重了自主神经的损害，使心率变异性降低。当2型糖尿病患者合并眼底、肾脏微血管病变时，应加强对其心率变异性的监测，以便于对糖尿病心脏自主神经功能早期作出诊断，减少2型糖尿病患者心源性猝死的发生。
목적：탐토심솔변이성여외주신경、하지동맥병변、시망막병변급신장병변등당뇨병만성병발증적관계。방법다학과연합문진、예약환자집중완성안저、신장、하지동맥병변등병발증사사；채용미국GE Marquette 공사생산적동태심전도궤급삼통도모의 V5、V1、avF도련기록기，기록심솔변이성시역、빈역지표。결과당뇨병조（96례）여정상대조조（136례）비교，당뇨병환자심솔변이성빈역급시역지표균강저（ P ＜0.05）；합병시망막병변적당뇨병환자，기전부정상두성심박간기적표준차（ SDNN）、5 min시간심박간기균치적표준차（ SDANN）、전정상린NN간기지차적균방차치（ RMSSD）、전부NN간기지차＞50 ms적심박수，제이총적NN간기개수，승이100（PNN50）균저우정상안저적당뇨병환자（ P ＜0.01， P ＜0.05）；합병신장병변환자적심솔변이성지표제저빈/고빈（ LF/HF）、평균두성NN간기（ MNN）외，기타지표균명현저우비신병조당뇨병환자（ P ＜0.01， P ＜0.05）；합병하지동맥병변여무병변적당뇨병환자비교，심솔변이성지표차이무통계학의의（ P ＞0.05）。결론당뇨병환자장기고혈당가중료자주신경적손해，사심솔변이성강저。당2형당뇨병환자합병안저、신장미혈관병변시，응가강대기심솔변이성적감측，이편우대당뇨병심장자주신경공능조기작출진단，감소2형당뇨병환자심원성졸사적발생。
Objective To investigate the relationship between heart rate variability ( HRV) and chronic complications in pa-tients with type 2 diabetes mellitus (T2DM).Methods A total of 96 patients with T2DM was given chronic complication assessment . Demographic data were obtained .Diabetic retinopathy , diabetic kidney disease , diabetic peripheral neuropathy ( DPN) , and peripher-al artery disease ( PAD) were diagnosed according to international clinical classification .The parameters of HRV in the patients with diabetes and non-diabetes were examined with24 h Holter recorder .Results The HRV parameters of type 2 diabetic patients were significantly lower than those of non-diabetes ( P <0.05 ) .HRV time domain parameters [ standard deviation of normal RR intervals (SDNN), standard deviation of 5-minute mean RR intervals (SDANN), root mean square difference among successive RR normal in-tervals ( RMSSD) ] were especially impaired in diabetic patients with retinopathy compared to those without retinopathy .HRV parame-ters except low-to-high frequency ratio ( LF/HF) and MNN were lower in diabetic patients with kidney disease than those without kid-ney disease .HRV parameters were no significant difference between patients with or without PAD .Conclusions HRV of diabetic pa-tient is lower.Diabetic retinopathy and kidney disease impact on the HRV .