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目的 探讨 2型糖尿病 (T2DM )合并冠心病 (CHD)的心率变异 (HRV)与QT离散度 (QTd)的关系。方法 选择 2 0 0 1- 0 2～ 2 0 0 4 - 0 2东莞市人民医院 2型糖尿病 33例 (B组 )、2型糖尿病合并冠心病 30例 (A组 )患者 ,同时选择正常人 2 1例做对照 (C组 ) ,分别做 2 4h动态心电图 ,经电脑系统分析得出HRV时域和频域分析参数 ,做常规 12导联同步心电图 ,测定QT间期及QTd。结果 (1)A组的HRV各项参数均低于B组和C组 (P<0 0 1) ,QTd均大于B组和C组 (P <0 0 5 ,P <0 0 1) ;B组的HRV各项参数亦均低于C组 (P <0 0 5 ) ,QTd亦均大于C组 (P <0 0 5 )。 (2 )A组和B组的QTd与SDNN、SDANN、SDNN index均存在着负相关 (P <0 0 5 )。结论 T2DM合并冠心病者心脏自主神经损害较单纯T2DM者重 ,前者迷走神经受损较后者更重。对T2DM及T2DM合并CHD患者常规 2 4h动态心电图检查 ,测量QTd是有益的 ,以便早期发现高危患者。
Objective To investigate the relationship between heart rate variability (HRV) and QT dispersion (QTd) in type 2 diabetes mellitus (T2DM) with coronary heart disease (CHD). Methods Twenty-two cases of type 2 diabetes mellitus (group B) and 30 cases of type 2 diabetes mellitus with coronary heart disease (group A) were selected from 2001 to 2002-2004. 1 case of control (C group), respectively, 24 hours Holter, HRV analysis of the time domain and frequency domain analysis of the parameters obtained by conventional 12-lead ECG, QT interval and QTd. Results (1) The parameters of HRV in group A were lower than those in group B and C (P <0.01), and the QTd in group A were higher than those in group B and C (P <0 05, P <0.01) The parameters of HRV group were also lower than those of C group (P <0 05), QTd also larger than C group (P 0 05). (2) There was a negative correlation between QTd and SDNN, SDANN and SDNN index in group A and group B (P <0.05). Conclusions Autonomic nerve damage in patients with T2DM complicated with coronary heart disease is more severe than that in patients with simple T2DM. The former has more damage to the vagus nerve than the latter. For T2DM and T2DM patients with CHD conventional 24-hour Holter monitoring, QTd is helpful to early detection of high-risk patients.