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目的探讨2型糖尿病(T2DM)患者血脂水平与心率变异性(HRV)的相关性。方法入选我院2013年1月至2014年12月T2DM患者211例,收集所有患者血脂各项指标、糖代谢指标和甲状腺功能等一般资料,按血脂水平分为血脂水平异常组(n=118)和正常组(n=93),血脂水平异常组再按总胆固醇(TC)和甘油三酯(TG)水平分为3个亚组,即:单纯TG升高组(n=56)、单纯TC升高组(n=17)和混合高血脂组(n=45)。记录并分析患者24 h动态心电图HRV各项参数值(SDNN、SDANN、RMSSD和PNN50)。结果与血脂正常组相比,血脂异常组平均心率(HR)升高,PNN50降低,组间差异具有统计学意义(P<0.05);血脂异常患者的亚组分析显示,组间SDNN和SDANN差异显著,均具有统计学意义(P<0.05),单纯TG升高组SDANN最低;单纯TG升高组糖化血红蛋白(Hb A1c)和PNN50显著低于单纯TC升高组,差异均具有统计学意义(P<0.05);采用多元线性回归分析结果显示,TG与PNN50呈负相关,空腹血糖(FPG)、25-羟维生素D[25-(OH)D]、最大QT与PNN50呈正相关(P<0.01)。结论血脂异常的T2DM患者HRV降低,对糖尿病患者加强HRV分析有助于早期诊断心脏自主神经病变,预防心血管事件的发生。
Objective To investigate the relationship between blood lipid level and heart rate variability (HRV) in type 2 diabetes mellitus (T2DM). Methods Totally 211 T2DM patients from January 2013 to December 2014 in our hospital were enrolled in this study. All the data of lipids, glucose metabolism and thyroid function were collected and divided into three groups according to the level of blood lipids (n = 118) And normol group (n = 93). The level of total cholesterol (TC) and triglyceride (TG) were divided into three subgroups according to abnormal blood lipid level: Elevated group (n = 17) and mixed hyperlipidemia group (n = 45). Record and analyze 24 h Holter HRV parameters (SDNN, SDANN, RMSSD and PNN50). Results The mean heart rate (HR) and PNN50 in dyslipidemia group were significantly lower than those in normal lipid group (P <0.05). The subgroup analysis of dyslipidemia patients showed that the differences in SDNN and SDANN (P <0.05). SDANN in TG group was the lowest. Hb A1c and PNN50 in TG group were significantly lower than those in TC group (P <0.05), the differences were statistically significant (P < P <0.05). The results of multivariate linear regression analysis showed that there was a negative correlation between TG and PNN50. There was a positive correlation between fasting blood glucose (FPG), 25-hydroxyvitamin D [25- (OH) D] and maximal QT and PNN50 ). Conclusions The HRV in T2DM patients with dyslipidemia is decreased. Strengthening HRV analysis in diabetic patients is helpful for the early diagnosis of cardiac autonomic neuropathy and prevention of cardiovascular events.