摘要
目的探究麦笛亚心率变异分析仪(Medeia 3000)在2型糖尿病(T2DM)心血管自主神经病变(CAN)中的诊断价值。方法纳入T2DM患者338例,分别采用人工方法及Medeia 3000进行心血管自主神经功能反射试验(CARTs),根据CAN诊断标准,将所有患者分为非CAN组(NCAN组,81例)、早期CAN组(ECAN组,105例)及CAN组(152例),收集所有患者的一般临床资料及实验室检查指标并分组进行比较。采用spearman相关分析评估两种方式检测结果的相关性。采用受试者工作特征(ROC)曲线分析Medeia 3000对T2DM CAN的诊断价值。结果ECAN组患者年龄、BUN及OC水平均高于NCAN组,eGFR低于NCAN组;CAN组患者年龄、糖尿病病程、BUN及UACR均高于NCAN组,eGFR、UA、白蛋白均低于NCAN组;CAN组患者年龄、糖尿病病程及UACR均高于ECAN组,白蛋白、β-CTX及PⅠNP均低于ECAN组(P<0.05)。Medeia 3000检测CARTs评分低于人工方法,深呼吸心率差得分、Valsalva指数得分及卧立位心率比值得分均高于人工方法(P<0.001)。NCAN组、ECAN组及CAN组患者两种方式检测CARTs评分依次升高,深呼吸心率差得分、Valsalva指数得分及卧立位心率比值得分均依次下降(P<0.001)。Spearman相关分析结果显示,人工方法与Medeia 3000检测CARTs评分及对应4项子参数(卧立位血压差、深呼吸心率差、Valsalva指数、卧立位心率比值)得分均呈正相关(P<0.001)。去除影响因素进行偏相关分析,结果显示上述两种方式测得的CARTs评分及对应4项子参数均呈正相关(P<0.001)。ROC曲线分析结果显示,Medeia 3000诊断T2DM CAN的ROC曲线下面积为0.831,取最佳截断值1.2分时,对应敏感度为67.1%、特异度为87.1%。结论Medeia 3000在T2DM CAN中具有较高的诊断价值,建议在临床上降低其诊断切点。
Objective To investigate the diagnostic value of Medeia 3000 in type 2 diabetics mellitus(T2DM)patients with cardiovascular autonomic neuropathy(CAN).Methods A total of 338 patients with T2DM were enrolled.Cardiovascular autonomic reflex tests(CARTs)were performed by both traditional manual methods and Medeia 3000.According to the diagnostic criteria of CAN,patients were divided into non-CAN group(NCAN group,81 cases),early CAN group(ECAN group,105 cases)and CAN group(152 cases),general clinical data and laboratory examination indexes of all patients were collected and compared between groups.Spearman correlation analysis was used to evaluate the correlation between the two methods.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of Medeia 3000 for CAN in T2DM.Results Age,BUN and OC levels in ECAN group were higher than those in NCAN group,and eGFR was lower than that in NCAN group;Age,duration of diabetes,BUN and UACR in CAN group were higher than those in NCAN group,and eGFR,UA and albumin were lower than those in NCAN group;Age,duration of diabetes and UACR in CAN group were higher than those in ECAN group,and albumin,β-CTX and PⅠNP were lower than those in ECAN group(P<0.05).The scores of CARTs from Medeia 3000 were lower than those from traditional manual methods,and the scores of heart rate difference during deep breathing,Valsalva index and heart rate ratio in supine and standing position were higher than those from traditional manual methods(P<0.001).The scores of CARTs increased in the order of NCAN,ECAN and CAN groups,while the scores of heart rate difference during deep breathing,Valsalva index and heart rate ratio decreased in the order of NCAN group,ECAN group and CAN group(P<0.001).Spearman correlation analysis showed that the scores of CARTs and four corresponding sub-parameters(difference in blood pressure in supine position,difference in heart rate during deep breathing,Valsalva index and ratio of heart rate in supine position)were positively correlated
作者
郭思敏
王维敏
朱大龙
毕艳
杨东辉
Guo Simin;Wang Weimin;Zhu Dalong;Bi Yan;Yang Donghui(Department of Endocrinology,Nanjing Drum Tower Hospital,Graduate School of Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing 210008,China;不详)
出处
《临床内科杂志》
CAS
2023年第7期471-474,共4页
Journal of Clinical Internal Medicine
关键词
2型糖尿病
心率变异性分析
心血管自主神经病变
心血管自主神经功能评分
Type 2 diabetes mellitus
Heart rate variability analysis
Cardiovascular autonomic neuropathy
Cardiovascular autonomic reflex tests
