Department of Internal Medicine 1, Faculty of Medicine, Oita University, Oita, Japan.
Circ J. 2010 Jul;74(7):1379-83. doi: 10.1253/circj.cj-09-0960. Epub 2010 Apr 29.
Cardiovascular autonomic neuropathy is a major complication in patients with diabetes mellitus (DM). However, the relationship between cardiovascular autonomic neuropathy and the incidence of cardiovascular events has been poorly investigated in type 2 DM. The present study aimed to assess the long-term cardiovascular predictive value of baroreflex sensitivity (BRS) in Japanese patients with type 2 DM without structural heart disease.
BRS was evaluated using the phenylephrine method in 210 patients with type 2 DM who did not have structural heart disease or other severe complications. BRS was considered depressed if <6 ms/mmHg. Accurate follow-up information for 3-10 years (mean 4.7 years) was obtained in 184 patients (90 females, 94 males; mean age 58+/-12 years). The initial onset of a major adverse cardiovascular event (MACE) was investigated. During follow-up, 19 patients presented with a MACE (4 cardiovascular deaths, 3 nonfatal myocardial infarctions, 4 coronary revascularizations, 5 strokes, 2 congestive heart failures). Cox proportional hazards regression analysis revealed that depressed BRS was independently associated with the incidence of MACE (hazard ratio 1.93, 95% confidence interval 1.09-3.82, P=0.0236).
Depressed BRS at baseline has long-term cardiovascular predictive value in Japanese patients with type 2 DM without structural heart disease.
心血管自主神经病变是糖尿病（DM）患者的主要并发症。然而，在 2 型糖尿病患者中，心血管自主神经病变与心血管事件的发生之间的关系尚未得到充分研究。本研究旨在评估在无结构性心脏病的日本 2 型糖尿病患者中，压力感受性反射敏感性（BRS）对心血管的长期预测价值。
在 210 例无结构性心脏病或其他严重并发症的 2 型糖尿病患者中，使用苯肾上腺素法评估 BRS。如果 <6 ms/mmHg，则认为 BRS 降低。184 例患者（90 例女性，94 例男性；平均年龄 58+/-12 岁）获得了 3-10 年（平均 4.7 年）的准确随访信息。研究了主要不良心血管事件（MACE）的初始发病情况。在随访期间，19 例患者出现 MACE（4 例心血管死亡，3 例非致死性心肌梗死，4 例冠状动脉血运重建，5 例中风，2 例充血性心力衰竭）。Cox 比例风险回归分析显示，基线时 BRS 降低与 MACE 的发生独立相关（危险比 1.93，95%置信区间 1.09-3.82，P=0.0236）。
在无结构性心脏病的日本 2 型糖尿病患者中，基线时 BRS 降低具有长期心血管预测价值。
