Cha Seon-Ah, Yun Jae-Seung, Lim Tae-Seok, Min Kyoungil, Song Ki-Ho, Yoo Ki-Dong, Park Yong-Moon, Ahn Yu-Bae, Ko Seung-Hyun
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2016 Oct 14;11(10):e0164807. doi: 10.1371/journal.pone.0164807. eCollection 2016.
Cardiovascular autonomic neuropathy (CAN) is a risk factor for cardiovascular disease (CVD) and mortality in patients with type 2 diabetes. This study evaluated the relationship between CAN and recurrent CVD in type 2 diabetes. A total of 206 patients with type 2 diabetes who had a history of CVD within 3 years of enrollment were consecutively recruited from January 2001 to December 2009 and followed-up until December 2015. Cardiovascular autonomic function tests were performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. We estimated the recurrence of CVD events during the follow-up period. A total of 159 (77.2%) of the 206 patients enrolled completed the follow up, and 78 (49.1%) patients had recurrent episodes of CVD, with an incidence rate of 75.6 per 1,000 patient-years. The mean age and diabetes duration were 62.5 ± 8.7 and 9.2 ± 6.9 years, respectively. Patients who developed recurrent CVD also exhibited hypertension (P = 0.004), diabetic nephropathy (P = 0.012), higher mean systolic blood pressure (P = 0.006), urinary albumin excretion (P = 0.015), and mean triglyceride level (P = 0.035) than did patients without recurrent CVD. Multivariable Cox hazard regression analysis revealed that definite CAN was significantly associated with an increased risk of recurrent CVD (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.39-6.60; P = 0.005). Definite CAN was an independent predictor for recurrent CVD in patients with type 2 diabetes who had a known prior CVD event.
心血管自主神经病变（CAN）是2型糖尿病患者发生心血管疾病（CVD）及死亡的一个危险因素。本研究评估了CAN与2型糖尿病患者复发性CVD之间的关系。2001年1月至2009年12月连续招募了206例在入组前3年内有CVD病史的2型糖尿病患者，并随访至2015年12月。使用以下心率变异性参数进行心血管自主功能测试：呼气与吸气比值、对瓦尔萨尔瓦动作及站立的反应。我们估计了随访期间CVD事件的复发情况。206例入组患者中共有159例（77.2%）完成了随访，78例（49.1%）患者出现CVD复发，发病率为每1000患者年75.6例。平均年龄和糖尿病病程分别为62.5±8.7岁和9.2±6.9年。发生复发性CVD的患者与未发生复发性CVD的患者相比，还表现出高血压（P = 0.004）、糖尿病肾病（P = 0.012）、平均收缩压更高（P = 0.006）、尿白蛋白排泄量更高（P = 0.015）以及平均甘油三酯水平更高（P = 0.035）。多变量Cox风险回归分析显示，确诊的CAN与复发性CVD风险增加显著相关（风险比[HR] 3.03；95%置信区间[CI] 1.39 - 6.60；P = 0.005）。确诊的CAN是有已知既往CVD事件的2型糖尿病患者复发性CVD的独立预测因素。
