摘要目的 了解糖尿病合并周围神经病变患者的自主神经功能.方法 2008年1月至2009年3月按随机数字表法抽取天津医科大学代谢病医院的117例2型糖尿病患者,分为2型糖尿病不伴下肢神经病变组(糖1组)59例和2型糖尿病伴下肢神经病变组(糖2组)58例.无糖尿病的对照组50例来源于我院健康体检者.受试对象均接受体重指数、收缩压、舒张压、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹胰岛素、稳态模型胰岛素抵抗指数、24 h动态心电图心率变异性(HRV)、乏式动作反应指数、30/15比值、呼吸差的检测.统计学处理采用卡方检验、方差分析、配对秩和检验.结果 (1)糖1组、糖2组患者心动周期标准差(SDNN)、每5 min R-R均值的标准差(SDANN)、每5 min R-R均值的标准差指数(SDNNIDX)、相邻R-R差值的均方根(rMSSD)、24 h内相邻R-R间期相差＞50 ms的个数占总心跳次数的百分比(pNN50),与对照组比较差异有统计学意义(F值分别为94.702、77.786、55.422、56.175、49.110,均P＜0.01);(2)对照组SDNN、rMSSD、pNN50日间节律分别为(113±20)ms、(31±15)ms、4%(0～45%),夜间节律分别为(104±25)ms、(38±18)ms、11%(0～45%),日夜间比较差异有统计学意义(t=2.472、4.629、5.007,均P＜0.05);糖1组SDNN Et间节律为(81±16)ms,夜间节律为(77±19)ms,日夜间节律比较差异无统计学意义(t=1.952,P＞0.05),糖2组SDNN、rMSSD、pNN50日间节律分别为(64±15)ms、(21±19)ms、1%(0～30%),夜间节律分别为(64±20)ms、18(7～97)ms、1%(0～28%),日夜间节律比较差异无统计学意义(t值分别为0.155、1.103、1.328,均P＞0.05).结论 2型糖尿病不伴及伴下肢神经病变组均存在自主神经功能受损,但后者的自主神经功能更明显受损.心率变异性时域指标的昼夜节律可有效判断自主神经损害.

abstractsObjective To evaluate autonomic nervous function of type 2 diabetes mellitus with lower extremity neuropathy.Methods Clinical and laboratory data of 117 type 2 diabetes mellitus (T2DM) patients and 50 healthy controls in Metabolism Hospital of Tianjin Medical University were analyzed between January 2008 and March 2009 and divided into 58 type 2 diabetes mellitus with lower extremity neuropathy (T2DM 1 group),and 59 type 2 diabetes mellitus without lower extremity neuropathy (T2DM 2 group).Heart rate variability (HRV) analysis and its circadian rhythm (CR) were determined from 24-hour Hoher recording.Body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),triglyceride (TG),total cholesterol (TC),high-density lipoprotein-cholesterol (HDL-C),low-density lipoprotein-cholesterol(LDL-C),fasting blood sugar(FBS),postprandial 2 h blood sugar (2 h PBS),glycated hemoglobin A-1c (HbA1c),fasting insulin (FINS),HOM A-IR,valsalva movement response index,30/15 ratio,the difference in respiration,were measured.ANOVA,x~2 test,and rank sum test were used for data analysis.Results (1) Timing domain parameter of HRV,standard deviation of all normal R-R intervals(SDNN) (F=94.702,P＜0.01),standard deviation of the average normal R-R intervals for 5-minute segments(SDANN)(F=77.786,P＜0.01),mean of the standard deviation of all normal R-R intervals for 5-minute segments (SDNNIDX) (F = 55.422,P ＜ 0.01),root mean square successive difference (rMSSD) (F=56.175,P＜0.01),of differences between adjacent normal R-R intervals＞50ms,(pNN50)(F=49.110,P ＜0.01)were significantly decreased in group T2DM 1 and T2DM 2.(2)Timing domain parameter of HRV in healthy controls,rMSSD,pNN50 was decreased in daytime ((31±15)ms,4% (0～45%),respectively) and increased in nighttime (35 (14～107) ms,(11.5% (0～54%),respectively),(t=4.629,5.007,P＜0.01),respectively),but SDNN was increased in daytime ((113±20)ms) and decreased in nighttime((104±25)ms) (t =2.472,P=0.013).CR of HRV,SDNN ((81±16),(77±19))ms,(t=1.952,P=0.051) was changed in T2DM 1.CR of HRV,SDNN((64±15),(64±20))ms,(t =0.155,P =0.877),rMSSD((21±19),(22±21))ms,(t=1.103,P=0.270),pNN50 1% (0～30%),1% (0～28%),(t= 1.328,P= 0.184) were disappeared in T2DM.Conclusion Impaired and serious impaired vegetative nervous function in type 2 diabetes mellitus without and with lower extremity neuropathy.CR of HRV is a useful parameter in assessing autonomic nervous function of type 2 diabetes mellitus without and with lower extremity neuropathy.