Silva Ticiana Paes, Rolim Luiz Clemente, Sallum Filho Celso, Zimmermann Livia M, Malerbi Fernando, Dib Sergio Atala
Division of Endocrinology and Metabolism, Federal University of São Paulo, São Paulo, Brazil.
Diabetes Metab Res Rev. 2017 Feb;33(2). doi: 10.1002/dmrr.2830. Epub 2016 Aug 1.
The occurrence of hypoglycemia has been associated with the presence of cardiovascular autonomic neuropathy. Cardiovascular autonomic reflex tests are the gold standard diagnostic method for cardiovascular autonomic neuropathy. Nevertheless, impaired heart rate variability indices on spectral analysis have been reported before cardiovascular autonomic reflex test abnormalities arise. The objective of the present study was to analyse the association between the severity of hypoglycemia and indices of heart rate variability on spectral analysis.
Consecutive type 1 diabetes patients were prospectively enrolled. Heart rate variability indices were assessed by spectral analysis. One abnormal test result was used to define impaired spectral analysis. The severity of hypoglycemia was evaluated by a hypoglycemia score and patients were classified into absent/minor or moderate/severe hypoglycemia groups.
Patients with moderate/severe hypoglycemia were older, had longer duration of diabetes and had higher rates of diabetic complications. After adjusting for baseline clinical characteristics, impaired spectral analysis (OR: 3.85; 95% IC 1.23 - 12.02; p = 0.020), nephropathy (OR: 4.15, 95% IC 1.27 - 13.54; p = 0.018) and macrovascular complications (OR: 12.18, 95% IC 1.14 - 129.84; p = 0.038) remained independent predictors of moderate/severe hypoglycemia. Patients with moderate/severe hypoglycemia had lower heart rate variability in the high frequency band of spectral analysis, reflecting a decreased parasympathetic tonus on the heart. These patients also had higher low frequency/high frequency ratios, ultimately denoting the occurrence of cardiovascular autonomic imbalance.
Impaired heart rate variability on spectral analysis, nephropathy and macrovascular complication were shown to independently predict moderate/severe hypoglycemia. Patients with moderate/severe hypoglycemia showed loss of the cardio protective effect of vagal activity according to spectral analysis. Copyright © 2016 John Wiley & Sons, Ltd.
低血糖的发生与心血管自主神经病变有关。心血管自主神经反射测试是诊断心血管自主神经病变的金标准方法。然而，在心血管自主神经反射测试出现异常之前，已有报道频谱分析中的心率变异性指数受损。本研究的目的是分析低血糖严重程度与频谱分析中的心率变异性指数之间的关联。
前瞻性纳入连续的1型糖尿病患者。通过频谱分析评估心率变异性指数。一项异常测试结果用于定义频谱分析受损。通过低血糖评分评估低血糖的严重程度，并将患者分为无/轻度或中度/重度低血糖组。
中度/重度低血糖患者年龄较大，糖尿病病程较长，糖尿病并发症发生率较高。在调整基线临床特征后，频谱分析受损（比值比：3.85；95%置信区间1.23 - 12.02；p = 0.020）、肾病（比值比：4.15，95%置信区间1.27 - 13.54；p = 0.018）和大血管并发症（比值比：12.18，95%置信区间1.14 - 129.84；p = 0.038）仍然是中度/重度低血糖的独立预测因素。中度/重度低血糖患者在频谱分析的高频段心率变异性较低，反映出心脏副交感神经张力降低。这些患者的低频/高频比值也较高，最终表明发生了心血管自主神经失衡。
频谱分析中的心率变异性受损、肾病和大血管并发症被证明可独立预测中度/重度低血糖。根据频谱分析，中度/重度低血糖患者显示出迷走神经活动的心脏保护作用丧失。版权所有© 2016约翰威立父子有限公司。
