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目的 了解初诊2型糖尿病患者的心血管自主神经病变(CAN)患病情况及其特点,比较Ewing试验及心率变异性(HRV)两种常用评价方法对诊断CAN的差异.方法 以2009年5月至2010年12月广东省4家医院(中山大学附属第三医院、汕头大学医学院第一附属医院、广东省人民医院、南方医科大学珠江医院)内分泌科收治的90例初诊2型糖尿病患者为糖尿病组,其中男58例,女32例,平均年龄(47±1)岁.以同期40名健康体检者为对照组,其中男21名,女19名,平均年龄为(45±2)岁.所有受试者均接受Ewing试验和24h动态心电图检查并分析HRV指标以诊断CAN,对比两种方法的结果差异.计量资料间比较采用t检验或单因素方差分析,等级资料采用秩和检验.结果 (1) Ewing试验显示糖尿病组CAN阳性率[22.2％( 20/90)]高于对照组[7.5％(3/40),x2=4.12,P＜0.05]；糖尿病组Ewing试验总评分(92.5分)高于对照组(7.0分,Z=-3.72,P＜O.Ol),Ewing试验各指标(Valsalva指数、深呼吸心率差、立卧位心率变化及血压差)评分均较对照组升高,差异均有统计学意义(Z值分别为-2.99、-2.23、-1.99、-2.36,均P＜0.05).(2)HRV分析显示糖尿病组CAN阳性率[34.4％(31/90)]高于对照组[12.5％(5/40),x2=6.66,P＜0.05]；糖尿病组HRV中反映副交感神经功能的指标[全部正常窦性心搏间期(N-N)的标准差、连续5 min正常R-R间期均值的标准差及低频功率]均降低,与对照组相比差异均有统计学意义(t值分别为2.06、2.24、6.48,均P＜0,05),而代表交感神经功能的指标(全程相邻N-N间期之差的均方根值、相邻R-R间期差异≥50 ms的百分数、高频功率)差异均无统计学意义(t值分别为0.27、0.15、1.40,均P＞0.05).结论 Ewing试验和HRV检测均显示初诊2型糖尿病患者中CAN阳性率较高,且以副交感神经损害为主；HRV检测较Ewing试验的CAN阳性率高.

Objective To assess the positive rate and characteristics of cardiovascular autonomic neuropathy (CAN) in patients with newly diagnosed type 2 diabetes and to compare Ewing test with heart rate variability (HRV) for identifying CAN.Methods Ninety newly diagnosed type 2 diabetic patients (diabetic group) and 40 healthy subjects (control group) were enrolled from Department of Endocrinology and Metabolism of 4 hospitals in Guangdong Province ( the Third Affiliated Hospital of Sun Yat-sen University,the First Affiliated Hospital of Shantou University Medical College,Guangdong General Hospital,Zhujiang Hospital of Southern Medical University).The diabetic group included 58 males and 32females,with an average age (47 ±l) years.The control group included 21 males and 19 females,with an average age (45 ±2) years.Standard Ewing test and Halter (HRV analysis) were used to evaluate CAN,and comparison of these two diagnostic methods was committed.Difference of measurement data was compared with t test or one-way ANOVA and rank sum test was used for ranked data.Results ( I ) The results of Ewing test showed that the positive rate of CAN in newly diagnosed type 2 diabetic patients (22.2％ (20/90)) was higher than that in the controls (7.5％ (3/40),x2 =4.12,P ＜0.05).The Ewing scores in the diabetic patients ( 92.5 ) were significantly higher than those in the controls ( 7.0,Z =-3.72,P ＜ 0.01 ).The indexes of Ewing test ( including valsalva ratio,heart-rate variation during deep breathing,heart rate and blood pressure response on s "tanding) in the diabetic patients( 92.5 ) were higher than those in the controls ( Z value was - 2.99,- 2.23,- 1.99 and - 2.36,respectively,all P ＜ 0.05 ).(2) HRV analysis showed that the positive rate of CAN in newly diagnosed type 2 diabetic patients (34.4％ (31/90) ),was higher than that in the controls ( 12.5％ ( 5/40 ),x2 =6.66,P ＜ O.05 ).HRV indices related to parasympathetic fanetion ( including standard deviation of all normal-to-normal ( N-N ) intervals ( SDNN),standard deviation of the averages of N-N intervals in all 5 min segments (SDANN) and power in the low frequency range (LF) in the diabetic patients significantly decreased compared with those in the controls ( t value was 2.06,2.24 and 6.48,respectively,all P ＜ 0.05 ),but there was no significant difference in those relaled to the sympathetic function such as root mean square of successive differences in R-R interval (RMSSD),percentage of R-R intervals differing more than 50 ms from the preceding one (PNNS0) and power in the high frequency range(HF) ( t value was 0.27,O.15 and 1.40,respectively,all P >0.05).Conclusions Both Ewing tests and HRV shewed a higher positive rate of CAN in the newly diagnosed type 2 diabetic patients than that in the control group,and parasympathetic function was mainly damaged.More CAN patients were detected by HRV than by Ewing test.