Fakhrzadeh Hossein, Yamini-Sharif Ahmad, Sharifi Farshad, Tajalizadekhoob Yaser, Mirarefin Mojde, Mohammadzadeh Maryam, Sadeghian Saeed, Badamchizadeh Zohre, Larijani Bagher
Elderly Health Research Center, Endocrinology & Metabolism Research Center, Tehran University of Medical Sciences, Dr Shariati University Hospital, North Kargar Avenue, Tehran, Iran ; Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, Iran.
ISRN Endocrinol. 2012;2012:168264. doi: 10.5402/2012/168264. Epub 2012 Dec 4.
Cardiac autonomic neuropathy (CAN) is a critical complication of type 2 diabetes mellitus (T2DM). Heart rate variability (HRV) is a noninvasive tool to assess cardiac autonomic function. We aimed to evaluate whether CAN is associated with increased risk of atherosclerosis in T2DM. A total of 57 diabetic and 54 nondiabetic subjects, free of coronary heart disease, were recruited. Carotid intima media thickness (CIMT), coronary calcium score (CAC), and brachial Flow Mediated Dilation (FMD) were measured. Heart rate variability and vagal components of autonomic function were determined. Significant reduction of normalized HF power (P < 0.05) and total power (P < 0.01) was observed in T2DM. CIMT and CAC scores were significantly higher while FMD was significantly lower in diabetics (P < 0.01 for all). Median HbA(1c) levels were significantly higher in diabetics. CIMT was inversely and independently associated with total power both in diabetics and controls (P < 0.01 for both groups). There was also an inverse association between total power and median HbA(1c). Autonomic dysfunction, especially parasympathetic neuropathy, was present since early-stage T2DM. This was related to subclinical atherosclerosis. Early detection of cardiac autonomic neuropathy can help us detect the development of atherosclerosis earlier in T2DM to prevent unfavorable outcomes.
心脏自主神经病变（CAN）是2型糖尿病（T2DM）的一种关键并发症。心率变异性（HRV）是评估心脏自主神经功能的一种非侵入性工具。我们旨在评估CAN是否与T2DM患者动脉粥样硬化风险增加相关。共招募了57名糖尿病患者和54名非糖尿病患者，他们均无冠心病。测量了颈动脉内膜中层厚度（CIMT）、冠状动脉钙化评分（CAC）和肱动脉血流介导的血管舒张功能（FMD）。测定了心率变异性和自主神经功能的迷走神经成分。在T2DM患者中观察到标准化高频功率（P < 0.05）和总功率（P < 0.01）显著降低。糖尿病患者的CIMT和CAC评分显著更高，而FMD显著更低（所有P < 0.01）。糖尿病患者的糖化血红蛋白（HbA1c）中位数水平显著更高。在糖尿病患者和对照组中，CIMT均与总功率呈负相关且独立相关（两组P < 0.01）。总功率与HbA1c中位数之间也存在负相关。自主神经功能障碍，尤其是副交感神经病变，在T2DM早期就已存在。这与亚临床动脉粥样硬化有关。早期检测心脏自主神经病变有助于我们在T2DM患者中更早地发现动脉粥样硬化的发展，以预防不良后果。
