Kardelen Firat, Akçurin Gayaz, Ertuğ Halil, Akcurin Sema, Bircan Iffet
Department of Pediatric Cardiology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
Pediatr Diabetes. 2006 Feb;7(1):45-50. doi: 10.1111/j.1399-543X.2006.00141.x.
Diabetic autonomic neuropathy (DAN) commonly complicates diabetes and is associated with increased mortality rates over 5 yr. This fact denotes the significance of DAN prevention, mainly with effective glycemic control. However, total prevention of autonomic neuropathy in diabetic patients is not achievable. Thus, the timely detection of DAN and the use of effective means to improve autonomic nervous system function or slow down its progression become of utmost significance. Heart rate variability (HRV) is a technique that measures the beat-to-beat variability in RR intervals, which reflects changes in autonomic activity and their impact on cardiovascular function. Circadian variation in time and frequency domains of heart variability has been shown to correlate with circadian rhythm of ambulatory ischemia and suggests that relative changes in vagal and sympathetic tone at different times during the day may have a direct relationship to the severity of clinical events. Forty-seven (21 boys and 26 girls) type I insulin-dependent diabetics and 46 control subjects (19 boys and 27 girls) were included in the study. Our investigation demonstrated that overall HRV is markedly depressed in diabetes mellitus (DM). All time domain parameters except standard deviation of all 5-min mean RR intervals and all frequency domain indices maintain significant circadian variation. These changes in overall HRV and HRV circadian rhythms reflect significant reductions in cardiac parasympathetic activity and, possibly, increased sympathetic tone.
糖尿病自主神经病变（DAN）常使糖尿病病情复杂化，并与5年以上的死亡率增加相关。这一事实表明预防DAN具有重要意义，主要是通过有效的血糖控制。然而，糖尿病患者的自主神经病变完全预防是无法实现的。因此，及时检测DAN并使用有效手段改善自主神经系统功能或减缓其进展变得至关重要。心率变异性（HRV）是一种测量RR间期逐搏变化的技术，它反映自主神经活动的变化及其对心血管功能的影响。心脏变异性的时间和频率域的昼夜变化已被证明与动态缺血的昼夜节律相关，并表明一天中不同时间迷走神经和交感神经张力的相对变化可能与临床事件的严重程度有直接关系。47名（21名男孩和26名女孩）I型胰岛素依赖型糖尿病患者和46名对照受试者（19名男孩和27名女孩）纳入了研究。我们的调查表明，糖尿病（DM）患者的总体HRV明显降低。除了所有5分钟平均RR间期的标准差外，所有时域参数和所有频域指标均保持显著的昼夜变化。总体HRV和HRV昼夜节律的这些变化反映了心脏副交感神经活动的显著降低，并且可能交感神经张力增加。
