Bissinger Andrzej, Ruxer Jan, Ahmed Rehana B, Lubinski Andrzej
Department of Invasive Cardiology and Cardiodiabetology, Medical University of Lodz, Lodz, Poland.
Arch Med Sci. 2014 Dec 22;10(6):1073-7. doi: 10.5114/aoms.2014.47819.
Cardiac autonomic neuropathy (CAN) causes substantial morbidity and increased mortality in patients with diabetes mellitus (DM). Besides heart rate variability (HRV), heart rate turbulence (HRT) is an important method of assessment of cardiac autonomic regulation. The aim of the study was to assess the correlation between HRT and diabetic control.
Fifty-nine patients met the inclusion criteria - 38 males and 21 females, age 64.4 ±7.6. The patients included had inadequately controlled DM type 2 defined as glycated haemoglobin (HbA1c) > 9% (mean 11.8 ±2.7%). In all patients, intensive insulin treatment had been applied for 6 months. After 6 months, HbA1c was measured. ECG Holter monitoring was performed before and after insulin treatment to evaluate the time domain HRV and HRT parameters (turbulence onset (TO) and turbulence slope (TS)).
After 6 months of intensive insulin treatment, HbA1c concentrations ranged from 6.3% (45 mmol/mol) to 11.2% (99 mmol/mol) - mean 8.5 ±3.8% (69 ±18 mmol/mol). Significant improvement of TO, TS and SDNN was observed. The TO and TS significantly correlated with HbA1c (r = 0.35, p = 0.006 and r = -0.31, p = 0.02 respectively). Among analyzed HRV time domain parameters such as SDNN, rMSSD and pNN50, only SDNN correlated with HbA1c (r = -0.41, p = 0.001). It was further concluded that intensive insulin therapy led to better glycemic control, resulting in improvement of HRT.
Heart rate turbulence may be useful in monitoring changes of the autonomic nervous system functions in patients with DM, similarly to HRV parameters.
心脏自主神经病变（CAN）在糖尿病（DM）患者中会导致严重发病并增加死亡率。除心率变异性（HRV）外，心率震荡（HRT）是评估心脏自主神经调节的重要方法。本研究的目的是评估HRT与糖尿病控制之间的相关性。
59例患者符合纳入标准，其中男性38例，女性21例，年龄64.4±7.6岁。纳入的患者为2型糖尿病控制不佳者，糖化血红蛋白（HbA1c）>9%（平均11.8±2.7%）。所有患者均接受了6个月的强化胰岛素治疗。6个月后，测量HbA1c。在胰岛素治疗前后进行心电图动态监测，以评估时域HRV和HRT参数（震荡起始（TO）和震荡斜率（TS））。
强化胰岛素治疗6个月后，HbA1c浓度范围为6.3%（45 mmol/mol）至11.2%（99 mmol/mol），平均8.5±3.8%（69±18 mmol/mol）。观察到TO、TS和SDNN有显著改善。TO和TS与HbA1c显著相关（r = 0.35，p = 0.006；r = -0.31，p = 0.02）。在分析的HRV时域参数如SDNN、rMSSD和pNN50中，只有SDNN与HbA1c相关（r = -0.41，p = 0.001）。进一步得出结论，强化胰岛素治疗可导致更好的血糖控制，从而改善HRT。
与HRV参数类似，心率震荡可能有助于监测糖尿病患者自主神经系统功能的变化。
