Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China (mainland).
Department of Endocrinology and Metabolism, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland).
Med Sci Monit. 2017 Nov 10;23:5354-5362. doi: 10.12659/msm.905240.
BACKGROUND The aim of this study was to create a screening system for diabetic cardiovascular autonomic neuropathy (DCAN) in diabetic patients. MATERIAL AND METHODS A Chinese cohort of 455 diabetic participants was recruited between 2011 and 2013. Short-term heart rate variability testing was used to evaluate cardiovascular autonomic function. A simple model was developed using multiple variable regression to include only significant risk factors that were simple and easily assessed. A DCAN score was determined based on the coefficients of the multiple variable model. This score was tested on the entire cohort of 455 diabetic patients and another independent, external cohort of 115 diabetic patients. RESULTS The screening system consisted of age, body mass index, duration of diabetes mellitus, and resting heart rate, and these factors were significantly (P<0.05) associated with DCAN. Receiver operating characteristic (ROC) curve analysis was done. The areas under the ROC curve were 0.798, 0.756, and 0.729 for the total sample, validation cohort, and external set, respectively. A cutoff DCAN score of 12 out of 25 produced optimal results for sensitivity (80.36%), specificity (58.27%), and percentage of patients that needed subsequent testing (43.55%) for the validation set. CONCLUSIONS The study concludes that a simple and practical DCAN screening can be applied for early intervention to delay or prevent the disease in the Chinese population.
本研究旨在为糖尿病患者创建一种糖尿病心血管自主神经病变(DCAN)的筛查系统。
2011 年至 2013 年间,招募了 455 名中国糖尿病患者进行队列研究。采用短期心率变异性检测评估心血管自主功能。使用多元回归建立一个简单的模型,仅包括简单且易于评估的显著危险因素。根据多元模型的系数确定 DCAN 评分。该评分在整个 455 例糖尿病患者队列和另一个独立的 115 例糖尿病患者外部队列中进行了测试。
该筛查系统由年龄、体重指数、糖尿病病程和静息心率组成,这些因素与 DCAN 显著相关(P<0.05)。进行了受试者工作特征(ROC)曲线分析。对于总样本、验证队列和外部队列,ROC 曲线下面积分别为 0.798、0.756 和 0.729。对于验证队列,DCAN 评分 12 分(满分 25 分)的截断值可产生最佳的敏感性(80.36%)、特异性(58.27%)和需要进一步检测的患者比例(43.55%)。
本研究得出结论,一种简单实用的 DCAN 筛查可用于中国人群的早期干预,以延缓或预防该疾病。