心血管自主神经病变(CAN)通过与心律失常和猝死的高风险相关而增加糖尿病的发病率和死亡率。可能与无症状心肌缺血有关。在亚临床阶段,可以通过心率变异性(HRV)的降低来检测CAN。我们研究的目的是评估时域和频域分析对于检测年轻1型糖尿病(T1DM)患者的CAN是否有价值。
对于这种心血管自主神经功能评估的对照研究,选择了T1DM持续时间超过9年的15-25岁患者组(n=208,男性89,女性119)。67例确诊的CAN患者被分配到“病例组”,141例无CAN患者作为对照组,两组患者的T1DM病程相似(15.07±4.89年对13.66±4.02年;p=0.06)。对所有受试者进行心血管自主神经反射测试以及HRV的时域和频域分析。
与对照组相比,CAN组的时域测量值显着降低(p<0.05)。在合并CAN的T1DM患者中,深呼吸期间R-Rmax/R-Rmin比值和变异系数(CV)最低。构建了接收器工作特性(ROC)曲线,以比较诊断CAN的时域分析参数的准确性。我们估计了更可靠的时域参数截止值。仰卧位的CV值<1.65,反映灵敏度94.3%,特异性91.5%。深呼吸时的CV值<1.45反映灵敏度97.3%,特异性96.2%。站立位置的CV值<1.50反映灵敏度96.2%,特异性93.0%。最有价值的CV是在深呼吸期间(AUC0.899)。频域(频谱分析)分析结果表明,LF功率和LFPA显着下降,HF电源和HFPA,与无CAN受试者相比,有CAN受试者的总功率(p<0.05)。HRV的时域和频域分析可以更准确地评估心血管自主神经功能,提供有关交感神经和副交感神经活动的更多信息。特别是在深呼吸期间的变异系数(时域分析)对于检测CAN可能是有价值的。
Cardiovascular autonomic neuropathy (CAN) increases morbidity and mortality in diabetes through association with a high risk of cardiac arrhythmias and sudden death, possibly related to silent myocardial ischemia. During the sub-clinical stage, CAN can be detected through reduction in heart rate variability (HRV). The aim of our study was to estimate if the time and frequency-domain analysis can be valuable for detecting CAN in young patients with type 1 diabetes mellitus (T1DM).
For this
case control study of evaluation of cardiovascular autonomic function the 15-25 years age group of patients with duration of T1DM more than 9 years (n = 208, 89 males and 119 females) were selected. 67 patients with confirmed CAN were assigned to the \"
case group\" and 141 patients without CAN served as a control group, the duration of T1DM was similar (15.07 ± 4.89 years vs.13.66 ± 4.02 years; p = 0.06) in both groups. Cardiovascular autonomic reflex tests and time and frequency domains analysis of HRV were performed for all subjects.
Time domain measures were significantly lower in CAN group compared with control (p < 0.05). R-R max / R-R min ratio and coefficient of variation (CV) were the lowest during deep breathing among T1DM patients with CAN. Receivers operating characteristic (ROC) curves were constructed to compare the accuracies of the parameters of time-domain analysis for diagnosing CAN. We estimated a more reliable cut-off value of parameters of time-domain. The CV values in supine position <1.65, reflected sensitivity 94.3%, specificity 91.5%. The CV values during deep breathing <1.45 reflected sensitivity 97.3%, specificity 96.2%. The CV values in standing position <1.50 reflected sensitivity 96.2%, specificity 93.0%. The most valuable CV was during deep breathing (AUC 0.899). The results of frequency-domain (spectral analysis) analysis showed significant decrease in LF power and LFPA, HF Power and HFPA, total power among subjects with CAN than compared with subjects without CAN (p < 0.05).
Time and frequency domain analysis of HRV permits a more accurate evaluation of cardiovascular autonomic function, providing more information about sympathetic and parasympathetic activity. The coefficient of variation (time-domain analysis) especially during deep breathing could be valuable for detecting CAN.