糖尿病对急性心肌梗死患者心率变异性的影响。
Impact of diabetes on heart rate variability in patients with acute myocardial infarction.
作者信息
Saleem Shemaila, Majeed Syed Muhammad Imran
机构信息
Department of Physiology, Federal Medical and Dental College, Islamabad.
Department of Clinical Cardiac Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi.
出版信息
J Ayub Med Coll Abbottabad. 2012 Apr-Jun;24(2):50-3.
BACKGROUND
Diabetes is a well-known cause of sudden mortality. Due to autonomic imbalance, those patients who are suffering from ischemic heart disease and diabetes concurrently are at a greater risk of manifesting arrhythmias. Heart rate variability (HRV) can be utilised for assessment of autonomic nervous system. The purpose of this study was to identify the values of HRV in diabetic and non-diabetic patients with acute myocardial infarction (AMI).
METHODS
This noninterventional descriptive study was carried out at Armed Forces Institute of Cardiology over a period of 6 months. A total of 50 healthy volunteers and 50 patients with myocardial infarction (MI) were Holter monitored for 24 hours and HRV was analysed in time and frequency domains.
RESULTS
The time domain indices; SDNN (non diabetics=78 +/- 30 ms vs diabetics = 58 +/- 20 ms; p = 0.01), SDANN (non diabetics = 68 +/- 28 ms vs diabetics = 49 +/- 19 ms; p = 0.23), SDNNi (non diabetics = 36 +/- 13 ms vs diabetics = 26 +/- 14 ms; p = 0.02), RMSSD (non diabetics = 29 +/- 11 ms vs diabetics = 23 +/-15 ms; p = 0.16) and pNN50 (non diabetics = 7 +/- 10 ms vs diabetics = 4 +/-12 ms; p = 0.43) were declined in diabetic patients with acute myocardial infarction when compared with non diabetic patients inflicted with infarction. Frequency domain indices, Total power (non diabetics = 1479 +/- 12 ms2 vs diabetics= 759+/- 6 ms2, p = 0.01), VLF (non diabetics = 997 +/- 9 ms2 vs diabetics =495 +/-5 ms2, p = 0.04), LF (non diabetics = 2921 +/- 2 ms2 vs diabetics = 123 +/- 1 ms2, p = 0.01) and HF (non diabetics = 121 +/-1 ms2 vs diabetics = 5 +/- 5 ms2, p =0.0)) showed attenuated HRV in diabetic patients with acute myocardial infarction. Comparison of diabetic and non diabetic infracted patients with healthy volunteers revealed decreased HRV in patients with myocardial infarction but gets even worse in diabetic patients with myocardial infarction.
CONCLUSIONS
Heart rate variability is attenuated in diabetic patients with acute myocardial infarction. It reflects sympatho-vagal imbalance in coronary patients with co-existent diabetes mellitus.
背景
糖尿病是猝死的一个众所周知的原因。由于自主神经失衡，同时患有缺血性心脏病和糖尿病的患者出现心律失常的风险更大。心率变异性（HRV）可用于评估自主神经系统。本研究的目的是确定HRV在糖尿病和非糖尿病急性心肌梗死（AMI）患者中的数值。
方法
这项非干预性描述性研究在武装部队心脏病学研究所进行，为期6个月。对50名健康志愿者和50名心肌梗死（MI）患者进行了24小时动态心电图监测，并在时域和频域分析了HRV。
结果
时域指标；SDNN（非糖尿病患者=78±30毫秒，糖尿病患者=58±20毫秒；p=0.01），SDANN（非糖尿病患者=68±28毫秒，糖尿病患者=49±19毫秒；p=0.23），SDNNi（非糖尿病患者=36±13毫秒，糖尿病患者=26±14毫秒；p=0.02），RMSSD（非糖尿病患者=29±11毫秒，糖尿病患者=23±15毫秒；p=0.16）和pNN50（非糖尿病患者=7±10毫秒，糖尿病患者=4±12毫秒；p=0.43）在急性心肌梗死糖尿病患者中与非糖尿病梗死患者相比有所下降。频域指标，总功率（非糖尿病患者=1479±12毫秒²，糖尿病患者=759±6毫秒²，p=0.01），极低频（VLF）（非糖尿病患者=997±9毫秒²，糖尿病患者=495±5毫秒²，p=0.04），低频（LF）（非糖尿病患者=2921±2毫秒²，糖尿病患者=123±1毫秒²，p=0.01）和高频（HF）（非糖尿病患者=121±1毫秒²，糖尿病患者=5±5毫秒²，p=0.0）显示急性心肌梗死糖尿病患者的HRV减弱。糖尿病和非糖尿病梗死患者与健康志愿者的比较显示，心肌梗死患者的HRV降低，但在糖尿病心肌梗死患者中更严重。
结论
急性心肌梗死糖尿病患者的心率变异性减弱。它反映了合并糖尿病的冠心病患者的交感-迷走神经失衡。
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