Larsen Jakob R, Sjøholm Hans, Berg Tore J, Sandvik Leiv, Brekke Magne, Hanssen Kristian F, Dahl-Jørgensen Knut
Diabetes Research Center, Aker and Ulleval University Hospitals, and Department of Pediatrics, Ulleval University Hospital, Oslo, Norway.
Diabetes Care. 2004 Apr;27(4):963-6. doi: 10.2337/diacare.27.4.963.
To study the association between 18 years of mean HbA(1c) and cardiac autonomic function in type 1 diabetic patients having used intensive insulin treatment.
A total of 39 patients with type 1 diabetes were followed during 18 years, and HbA(1c) was measured yearly. At 18 years follow-up heart rate variability (HRV) measurements were used to assess cardiac autonomic function. Standard cardiac autonomic tests during normal breathing, deep breathing, the Valsalva maneuver, and the tilt test were performed. Maximal heart rate increase during exercise electrocardiogram and minimal heart rate during sleep were also used to describe cardiac autonomic function.
We present the results for patients with mean HbA(1c) <8.4% (two lowest HbA(1c) tertiles) compared with those with HbA(1c) > or = 8.4% (highest HbA(1c) tertile). All of the cardiac autonomic tests were significantly different in the high- and the low-HbA(1c) groups, and the most favorable scores for all tests were seen in the low-HbA(1c) group. In the low-HbA(1c) group, the HRV was 40% during deep breathing, and in the high-HbA(1c) group, the HRV was 19.9% (P = 0.005). Minimal heart rate at night was significantly lower in the low-HbA(1c) groups than in the high-HbA(1c) group (P = 0.039). With maximal exercise, the increase in heart rate was significantly higher in the low-HbA(1c) group compared with the high-HbA(1c) group (P = 0.001).
Mean HbA(1c) during 18 years was associated with cardiac autonomic function. Cardiac autonomic function was preserved with HbA(1c) <8.4%, whereas cardiac autonomic dysfunction was impaired in the group with HbA(1c) > or = 8.4%.
研究接受强化胰岛素治疗的1型糖尿病患者18年平均糖化血红蛋白（HbA1c）与心脏自主神经功能之间的关联。
对39例1型糖尿病患者进行了为期18年的随访，每年测量HbA1c。在18年随访时，采用心率变异性（HRV）测量来评估心脏自主神经功能。进行了正常呼吸、深呼吸、瓦尔萨尔瓦动作和倾斜试验期间的标准心脏自主神经测试。运动心电图期间的最大心率增加和睡眠期间的最低心率也用于描述心脏自主神经功能。
我们展示了平均HbA1c<8.4%（最低的两个HbA1c三分位数）患者与HbA1c≥8.4%（最高的HbA1c三分位数）患者的结果。高HbA1c组和低HbA1c组的所有心脏自主神经测试均存在显著差异，所有测试中最有利的分数出现在低HbA1c组。在低HbA1c组中，深呼吸时HRV为40%，在高HbA1c组中，HRV为19.9%（P = 0.005）。低HbA1c组夜间最低心率显著低于高HbA1c组（P = 0.039）。在最大运动量时，低HbA1c组的心率增加显著高于高HbA1c组（P = 0.001）。
18年的平均HbA1c与心脏自主神经功能相关。HbA1c<8.4%时心脏自主神经功能得以保留，而HbA1c≥8.4%的组中心脏自主神经功能受损。
