Cho Yoon Hi, Craig Maria E, Srinivasan Shubha, Benitez-Aguirre Paul, Mitchell Paul, Jopling Tracey, Donaghue Kim C
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health & Department of Ophthalmology, University of Sydney, Sydney, NSW, Australia.
Clin Endocrinol (Oxf). 2014 Jun;80(6):818-24. doi: 10.1111/cen.12238. Epub 2013 Jun 6.
To examine the association between glycaemic control, insulin resistance and hyperandrogenism on cardiac autonomic function in peripubertal girls with type 1 diabetes.
Prospective, clinic-based study of 125 girls with diabetes and 46 age-matched nondiabetic girls.
Heart rate variability (HRV) parameters derived from a 10-min ECG recording using LabChart Pro were as follows: standard deviation of mean NN intervals (SDNN), where NN = adjacent QRS complexes; root mean squared difference of successive NN intervals (RMSSD) - estimates of overall HRV; and low-/high-frequency (LF:HF) ratio - an estimate of the sympathovagal balance. Androgens and sex hormone binding globulin (SHBG) were measured in girls with diabetes, and free androgen index (FAI) calculated. HRV and anthropometry were measured in nondiabetic controls.
Adolescents with diabetes (median age 15·1 years [13·3-16·0], diabetes duration 7·0 years [4·6-10·0] and median HbA1c 8·4% [7·5-9·3]) had higher HR and lower HRV compared with controls. Using multivariate models in the diabetes group, higher HR was associated with higher HbA1c, total daily dose insulin/kg body weight and systolic BP standard deviation scores (SDS), whilst reduced HRV was associated with higher HbA1c (SDNN, RMSSD and LF:HF ratio), lower SHBG (SDNN and RMSSD) and higher weight SDS (LF:HF ratio). Higher FAI was associated with higher HR and reduced HRV measures in the univariate analyses only.
In adolescent girls with diabetes, reduced HRV parameters are associated with worse glycaemic control, lower SHBG and higher weight SDS. SHBG should be considered in the cardiac risk models for this population.
研究1型糖尿病青春期前女孩的血糖控制、胰岛素抵抗和高雄激素血症与心脏自主神经功能之间的关联。
对125名糖尿病女孩和46名年龄匹配的非糖尿病女孩进行基于诊所的前瞻性研究。
使用LabChart Pro软件通过10分钟心电图记录得出的心率变异性（HRV）参数如下：平均NN间期标准差（SDNN），其中NN为相邻QRS波群；连续NN间期的均方根差（RMSSD）——总体HRV的估计值；以及低频/高频（LF:HF）比值——交感神经与迷走神经平衡的估计值。对糖尿病女孩测量雄激素和性激素结合球蛋白（SHBG），并计算游离雄激素指数（FAI）。对非糖尿病对照组测量HRV和人体测量指标。
糖尿病青少年（中位年龄15.1岁[13.3 - 16.0]，糖尿病病程7.0年[4.6 - 10.0]，HbA1c中位数8.4%[7.5 - 9.3]）与对照组相比，心率较高，HRV较低。在糖尿病组中使用多变量模型，较高的心率与较高的HbA1c、每日胰岛素总剂量/千克体重以及收缩压标准差评分（SDS）相关，而HRV降低与较高的HbA1c（SDNN、RMSSD和LF:HF比值）、较低的SHBG（SDNN和RMSSD）以及较高的体重SDS（LF:HF比值）相关。仅在单变量分析中，较高的FAI与较高的心率和降低的HRV指标相关。
在患有糖尿病的青春期女孩中，HRV参数降低与血糖控制较差、SHBG较低以及体重SDS较高相关。在该人群的心脏风险模型中应考虑SHBG。
