心血管自主神经病变(CAN)在2型糖尿病(T2DM)患者中很常见,主要表现为心率变异性(HRV)降低,通常导致心脏死亡。然而,HRV测量在大多数诊所都不方便。因此,通过更容易的测量来识别糖尿病患者的高危CAN对于早期干预和预防灾难性后果至关重要.
在这项横断面研究中,选择675例有正常钙血症的T2DM患者。其中,他们分为两组:正常HRV组(n=425,100ms≤SDNN≤180ms)与HRV下降组(n=250,SDNN<100ms)。收集所有患者的临床资料,采用相关和logistic回归分析临床变量与HRV的相关性。ROC曲线下的面积用于评估血清钙对HRV的预测性能。
在这项研究中,37.0%的T2DM患者存在HRV下降.白蛋白调整血清钙水平(CaA)的显着差异(8.86±0.27vs.9.13±0.39mg/dl,p<0.001)和E/A(0.78±0.22vs.在HRV下降组和HRV正常组之间观察到0.83±0.26,p=0.029)。双变量线性相关分析表明,CaA和E/A与包括SDNN在内的HRV参数呈正相关(p<0.001),SDNN指数(p<0.001),和三角指数(p<0.05)。ROC曲线中预测CaA对HRV的AUC为0.730(95%CI(0.750-0.815),p<0.001)。CaA的截断值为8.87mg/dl(敏感性0.644,特异性0.814)。CaA<8.87mg/dl的T2DM患者的HRV参数明显降低(SDNN,SDNN索引,rMSSD,和三角形指数)比CaA≥8.87mg/dl的那些(分别为p<0.01)。多因素logistic回归分析显示,CaA水平<8.87mg/dl[OR(95%CI),0.049(0.024-0.099),p<0.001]。
降低的HRV与较低的CaA水平和较差的心脏功能相关。血清钙水平可用于T2DM患者HRV下降的风险评估,甚至在正常血钙范围内。
Cardiovascular autonomic neuropathy (CAN) is common in patients with type 2 diabetes mellitus (T2DM), mainly presented as decreased heart rate variability (HRV) which often leads to cardiac death. However, HRV measurement is not convenient in most clinics. Therefore, identifying high-risk patients for CAN in diabetes with easier measurements is crucial for the early intervention and prevention of catastrophic consequences.
In this cross-sectional study, 675 T2DM patients with normocalcemia were selected. Of these, they were divided into two groups: normal HRV group (n = 425, 100 ms≤
SDNN ≤180 ms) vs. declined HRV group (n = 250,
SDNN <100 ms). All patients\' clinical data were collected and the correlation of clinical variables with HRV were analyzed by correlation and logistic regression analysis. The area below the ROC curve was used to evaluate the predictive performance of serum calcium on HRV.
In this study, declines in HRV were present in 37.0% of T2DM patients. Significant differences in albumin-adjusted serum calcium levels (CaA) (8.86 ± 0.27 vs. 9.13 ± 0.39 mg/dl, p <0.001) and E/A (0.78 ± 0.22 vs. 0.83 ± 0.26, p = 0.029) were observed between declined HRV and normal HRV groups. Bivariate linear correlation analysis showed that CaA and E/A were positively correlated with HRV parameters including
SDNN (p < 0.001),
SDNN index (p < 0.001), and Triangle index (p < 0.05). The AUC in the ROC curve for the prediction of CaA on HRV was 0.730 (95% CI (0.750-0.815), p < 0.001). The cutoff value of CaA was 8.87 mg/dl (sensitivity 0.644, specificity 0.814). The T2DM patients with CaA <8.87 mg/dl had significantly lower HRV parameters (
SDNN,
SDNN index, rMSSD, and triangle index) than those with CaA ≥8.87 mg/dl (p < 0.01, respectively). Multivariate logistic regression analysis showed a significantly increased risk of declined HRV in subjects with CaA level <8.87 mg/dl [OR (95% CI), 0.049 (0.024-0.099), p < 0.001].
Declined HRV is associated with a lower CaA level and worse cardiac function. The serum calcium level can be used for risk evaluation of declined HRV in T2DM patients even within the normocalcemic range.