目的分析2型糖尿病(T2DM)患者心脏自主神经病变的相关危险因素。方法采取随机抽样法选择2020年2—12月于上海中医药大学附属上海市中西医结合医院内分泌科住院的154例T2DM患者作为研究对象,患者均接受心血管反射试验,以心血管反射试验...目的分析2型糖尿病(T2DM)患者心脏自主神经病变的相关危险因素。方法采取随机抽样法选择2020年2—12月于上海中医药大学附属上海市中西医结合医院内分泌科住院的154例T2DM患者作为研究对象,患者均接受心血管反射试验,以心血管反射试验为诊断糖尿病心脏自主神经病变(DCAN)的金标准,分为DCAN组和无DCAN组,同时记录患者一般资料及生化指标等,分析DCAN的相关危险因素及对DCAN发生发展的预测价值。结果154例T2DM患者中,DCAN患者101例,无DCAN患者53例,DCAN发生率为65.6%(101/154)。两组间年龄、糖尿病病程比较差异有统计学意义(P<0.01),DCAN组糖尿病周围神经病变比例、胱抑素C(CysC)水平高于无DCAN组[75.25%(76/101)比56.60%(30/53),0.87(0.78,0.99)mg/L比0.79(0.73,0.92)mg/L](χ^(2)=5.632,P=0.018;Z=2.808,P=0.005),空腹C肽(FCP)低于无DCAN组[(1.86±0.95)μg/L比(2.34±1.12)μg/L](t=2.817,P=0.005)。两组性别、高血压比例、体质指数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、肿瘤坏死因子-α、神经元特异性烯醇化酶、同型半胱氨酸(Hcy)、糖化血红蛋白、血肌酐、尿酸、空腹血糖、餐后2 h血糖(2 h PG)比较差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:Hcy、2 h PG、FCP均为DCAN的独立影响因素(OR=1.272,95%CI 1.078~1.501;OR=1.098,95%CI 1.003~1.201;OR=0.528,95%CI 0.335~0.832,P<0.05或P<0.01)。受试者工作特征曲线分析显示,Hcy、2 h PG、FCP的曲线下面积分别为0.574、0.564、0.627。结论Hcy、2 h PG、FCP均为DCAN的独立影响因素,三者AUC面积均处于0.5~0.7,对诊断DCAN具有一定预测价值。展开更多
AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease(GERD).METHODS: The investigation was performed on 29patients(14 men), aged 18-80 years(51.14 ± 18.34)...AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease(GERD).METHODS: The investigation was performed on 29patients(14 men), aged 18-80 years(51.14 ± 18.34),who were referred to our Neurocardiology Laboratory at the Clinical and Hospital Center "Bezanijska Kosa"with a diagnosis of GERD. One hundred sixteen healthy volunteers matched in age and sex with the examinees served as the control group. The study protocol included the evaluation of autonomic function and hemodynamic status, short-term heart rate variability(HRV) analysis, 24 h ambulatory ECG monitoring with long-term HRV analysis and 24 h ambulatory blood pressure monitoring.RESULTS: Pathologic results of cardiovascular reflex test were more common among patients with reflux compared to the control group. Severe autonomic dysfunction was detected in 44.4% of patients and in7.9% of controls(P < 0.001). Parameters of short-term analysis of RR variability, which are the indicators ofvagal activity, had lower values in patients with GERD than in the control group. Long-term HRV analysis of time-domain parameters indicated lower values in patients with reflux disease when compared to the control group. Power spectral analysis of long-term HRV revealed lower low- and high-frequency values.Detailed 24 h ambulatory blood pressure analysis showed significantly higher values of systolic blood pressure and pulse pressure in the reflux group than in the control group.CONCLUSION: Patients with GERD have distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more congruent to GERD.展开更多
文摘目的分析2型糖尿病(T2DM)患者心脏自主神经病变的相关危险因素。方法采取随机抽样法选择2020年2—12月于上海中医药大学附属上海市中西医结合医院内分泌科住院的154例T2DM患者作为研究对象,患者均接受心血管反射试验,以心血管反射试验为诊断糖尿病心脏自主神经病变(DCAN)的金标准,分为DCAN组和无DCAN组,同时记录患者一般资料及生化指标等,分析DCAN的相关危险因素及对DCAN发生发展的预测价值。结果154例T2DM患者中,DCAN患者101例,无DCAN患者53例,DCAN发生率为65.6%(101/154)。两组间年龄、糖尿病病程比较差异有统计学意义(P<0.01),DCAN组糖尿病周围神经病变比例、胱抑素C(CysC)水平高于无DCAN组[75.25%(76/101)比56.60%(30/53),0.87(0.78,0.99)mg/L比0.79(0.73,0.92)mg/L](χ^(2)=5.632,P=0.018;Z=2.808,P=0.005),空腹C肽(FCP)低于无DCAN组[(1.86±0.95)μg/L比(2.34±1.12)μg/L](t=2.817,P=0.005)。两组性别、高血压比例、体质指数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、肿瘤坏死因子-α、神经元特异性烯醇化酶、同型半胱氨酸(Hcy)、糖化血红蛋白、血肌酐、尿酸、空腹血糖、餐后2 h血糖(2 h PG)比较差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:Hcy、2 h PG、FCP均为DCAN的独立影响因素(OR=1.272,95%CI 1.078~1.501;OR=1.098,95%CI 1.003~1.201;OR=0.528,95%CI 0.335~0.832,P<0.05或P<0.01)。受试者工作特征曲线分析显示,Hcy、2 h PG、FCP的曲线下面积分别为0.574、0.564、0.627。结论Hcy、2 h PG、FCP均为DCAN的独立影响因素,三者AUC面积均处于0.5~0.7,对诊断DCAN具有一定预测价值。
文摘AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease(GERD).METHODS: The investigation was performed on 29patients(14 men), aged 18-80 years(51.14 ± 18.34),who were referred to our Neurocardiology Laboratory at the Clinical and Hospital Center "Bezanijska Kosa"with a diagnosis of GERD. One hundred sixteen healthy volunteers matched in age and sex with the examinees served as the control group. The study protocol included the evaluation of autonomic function and hemodynamic status, short-term heart rate variability(HRV) analysis, 24 h ambulatory ECG monitoring with long-term HRV analysis and 24 h ambulatory blood pressure monitoring.RESULTS: Pathologic results of cardiovascular reflex test were more common among patients with reflux compared to the control group. Severe autonomic dysfunction was detected in 44.4% of patients and in7.9% of controls(P < 0.001). Parameters of short-term analysis of RR variability, which are the indicators ofvagal activity, had lower values in patients with GERD than in the control group. Long-term HRV analysis of time-domain parameters indicated lower values in patients with reflux disease when compared to the control group. Power spectral analysis of long-term HRV revealed lower low- and high-frequency values.Detailed 24 h ambulatory blood pressure analysis showed significantly higher values of systolic blood pressure and pulse pressure in the reflux group than in the control group.CONCLUSION: Patients with GERD have distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more congruent to GERD.
