摘要： 目的 探讨糖尿病肾病患者心率变异性（HRV）的变化及其与肾功能的相关性。方法 回顾性分析我院2型糖尿病住院患者（糖尿病组）142例的临床资料，依据患者是否合并糖尿病肾病，进一步分为糖尿病肾病组（62例）和糖尿病无肾病组（80例），选取同期健康体检者作为对照组（80例）。记录各组患者24 h动态心电图HRV中时域和频域的指标，记录糖尿病肾病组患者肾小球滤过率（eGFR）和尿微量白蛋白/肌酐指标，并进行统计学分析。结果 糖尿病组的HRV较对照组降低，差异有统计学意义（P<0.05），糖尿病肾病组HRV较糖尿病无肾病组更低，差异有统计学意义（P<0.05）。糖尿病肾病组患者eGFR与HRV时域指标正常窦性RR间期总体标准差（SDNN）、正常连续窦性RR间期差值均方根（rMSSD）、相邻RR间期差值>50 ms占间期总数的百分比（PNN50%）、频域指标中的低频成分（LF）、高频成分（HF）呈正相关（P<0.05），尿微量白蛋白/肌酐与HRV时域指标SDNN、窦性RR间期均值标准差（SDANN）、PNN50%、频域指标中的极低频成分（VLF）、LF呈负相关（P<0.05）。结论 糖尿病患者HRV降低，糖尿病肾病使其进一步加重，HRV的变化与患者的肾功能相关。

糖尿病肾病患者心率变异性的变化及其与肾功能的相关性

蒋玲玲¹, 辛雨¹, 李晓东²

1. 中国医科大学附属盛京医院 心功能科, 沈阳 110004;
2. 中国医科大学附属盛京医院 心内科, 沈阳 110004

收稿日期:2019-04-17出版日期:2020-05-30发布日期:2020-05-13
通讯作者:李晓东E-mail:lixdcmu@126.com
作者简介:蒋玲玲(1988-),女,医师,硕士.



关键词: 心率变异性, 糖尿病肾病, 肾小球滤过率, 尿微量白蛋白
Abstract: Objective To investigate the changes in heart rate variability(HRV) in patients with diabetic nephropathy and their correlation with renal function. Methods Patients with type 2 diabetes mellitus who were admitted to our hospital were enrolled in the diabetes mellitus group(142 patients). According to the presence of diabetic nephropathy,the patients were divided into the diabetic nephropathy group(62 patients) and diabetic non-nephropathy group(80 patients). Eighty healthy controls were enrolled in the control group. The time- and frequency-domain indexes of HRV in each group were recorded using 24-h Holter monitoring. The estimated glomerular filtration rate(eGFR) and urinary microalbumin/creatinine index were recorded for patients with diabetic nephropathy,and statistical analysis was performed. Results The HRV of the diabetic group was lower than that of the control group(P<0.05). The HRV of the diabetic nephropathy group was lower than that of the diabetic non-nephropathy group(P<0.05). In the diabetic nephropathy group,the eGFR was positively correlated with the domain indicators standard deviation of the normal NN intervals(SDNNs),root mean square of the successive differences,percentage of adjacent NN intervals that differ from each other by >50 ms(PNN50%),and lowfrequency(LF) or high-frequency domain indicators(P<0.05). The urinary microalbumin-to-creatinine ratio was negatively correlated with SDNN,SDANN,PNN50%,and very LF and LF domain indicators (P<0.05). Conclusion HRV decreases in patients with diabetes,and diabetic nephropathy further aggravates low HRV. Changes in HRV are associated with renal function.
Key words: heart rate variability, diabetic nephropathy, glomerular filtration rate, urinary microalbumin
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