[QTc间期在2型糖尿病心脏自主神经病变诊断中的应用]

[Utility of QTc interval for the diagnosis of cardiac autonomic neuropathy in type 2 diabetes mellitus].

作者信息

Matel Daniela, Chiochină Al D, Stratone Ana

机构信息

Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi, Facultatea de Bioinginerie Medicală, Catedra Stiinţe Biomedicale Facultatea de Medicină.

出版信息

Rev Med Chir Soc Med Nat Iasi. 2010 Jan-Mar;114(1):282-6.

PMID:20509317

Abstract

UNLABELLED

Prolonged QTc interval is a rapid objective method for detecting diabetic cardiac autonomic neuropathy (CAN). Diabetic CAN is a well recognized complication of diabetes mellitus type 2, and its incidence has been reported to be 20-40%, but detection of CAN is not a practical screening method for a large number of diabetic patients.

METHOD

65 cases of type 2 diabetes mellitus with no clinical evidence of cardiac disease were subjected to a battery of 5 non-invasive autonomic function tests as recommended by Ewing; these included deep breath test, orthostatic stress (30:15 ratio), Valsalva ratio, diastolic blood pressure rise with sustained hand grip, and postural hypotension on standing. A score of 2 or larger denoted CAN. QT interval was calculated by Atria 3100 interpretive electrocardiograph. The QTc was determined with Bazett's formula, and a value exceeding 440 msec was considered prolonged.

RESULTS

24 cases of type 2 diabetes mellitus (36.92%) were found to have CAN. QTc prolongation was observed in diabetics (433.89 +/- 30.37 ms) by comparison with control group 421.2 +/- 24.6 ms (F = 4.9, p = 0.03). QTc was much higher in diabetics with CAN (442.4 +/- 32.69 ms) vs. diabetics without CAN (424.48 +/- 23.45 ms). QTc prolongation correlated positively with the degree of cardiac autonomic neuropathy.

CONCLUSIONS

The study has shown that QTc prolongation is an easy and specific testing method for diabetic cardiac autonomic failure.

摘要

未标注

QTc间期延长是检测糖尿病性心脏自主神经病变（CAN）的一种快速客观方法。糖尿病性CAN是2型糖尿病一种公认的并发症，据报道其发病率为20% - 40%，但对于大量糖尿病患者而言，CAN的检测并非一种实用的筛查方法。

方法

65例无心脏病临床证据的2型糖尿病患者接受了尤因推荐的一系列5项非侵入性自主神经功能测试；这些测试包括深呼吸试验、直立应激（30:15比值）、瓦尔萨尔瓦比值、持续握力时舒张压升高以及站立时体位性低血压。得分2分或更高表示存在CAN。QT间期通过Atria 3100解释性心电图仪计算得出。采用巴泽特公式确定QTc，超过440毫秒的值被认为是延长。

结果

发现24例2型糖尿病患者（36.92%）存在CAN。与对照组（421.2 ± 24.6毫秒）相比，糖尿病患者观察到QTc延长（433.89 ± 30.37毫秒）（F = 4.9，p = 0.03）。存在CAN的糖尿病患者QTc（442.4 ± 32.69毫秒）明显高于无CAN的糖尿病患者（424.48 ± 23.45毫秒）。QTc延长与心脏自主神经病变程度呈正相关。