Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
J Clin Endocrinol Metab. 2018 Mar 1;103(3):1130-1138. doi: 10.1210/jc.2017-02294.
Cardiovascular autonomic neuropathy (CAN) diagnosed by diminished heart rate variability (HRV) is prevalent and carries an increased risk of mortality in patients with diabetes and chronic liver diseases.
To determine whether lower HRV is associated with increased liver fat content in recent-onset diabetes.
Cross-sectional study.
German Diabetes Study (GDS), Düsseldorf, Germany.
Individuals with type 1 diabetes (n = 97) or type 2 diabetes (n = 109) with known diabetes duration ≤1 year and two age- and sex-matched glucose-tolerant control groups from the GDS baseline cohort.
Four time and frequency domain HRV indices each were measured over 3 hours during a hyperinsulinemic-euglycemic clamp, whereas spontaneous cross-correlation baroreflex sensitivity (xBRS) was computed over 5 minutes. Hepatic fat content was determined by 1H magnetic resonance spectroscopy, and values >5.56% were defined as hepatic steatosis.
Hepatic steatosis was observed in 52% and 5% of patients with type 2 and type 1 diabetes, respectively. After adjustment for sex, age, body mass index, smoking, diabetes duration, hemoglobin A1c, M-value, and triglycerides, all four vagus-mediated time domain HRV indices, three of four frequency domain indices, and xBRS were inversely associated with liver fat content in participants with type 2 diabetes (all P < 0.05) but not in the group with type 1 diabetes.
Both lower cardiovagal tone and baroreflex sensitivity are strongly associated with prevalent hepatic steatosis in patients with recent-onset type 2 as opposed to type 1 diabetes, suggesting a role for hepatic steatosis in the early development of parasympathetic CAN in type 2 diabetes.
心血管自主神经病变（CAN）通过心率变异性（HRV）降低来诊断，在患有糖尿病和慢性肝病的患者中，CAN 发病率高且死亡率增加。
确定新发糖尿病患者中较低的 HRV 是否与肝脂肪含量增加有关。
横断面研究。
德国糖尿病研究（GDS），德国杜塞尔多夫。
GDS 基线队列中，已知糖尿病病程≤1 年的 1 型糖尿病（n=97）或 2 型糖尿病（n=109）患者各 97 名和 109 名，以及两组年龄和性别匹配的糖耐量正常对照组。
在胰岛素高血糖正常钳夹过程中，连续 3 小时内测量 4 个时频域 HRV 指数，同时计算 5 分钟内的自发交叉相关压力感受性反射敏感性（xBRS）。通过 1H 磁共振波谱法测定肝脂肪含量，肝脂肪含量>5.56%定义为肝脂肪变性。
2 型和 1 型糖尿病患者中分别有 52%和 5%存在肝脂肪变性。校正性别、年龄、体重指数、吸烟、糖尿病病程、糖化血红蛋白、M 值和甘油三酯后，2 型糖尿病患者中所有 4 个迷走神经介导的时域 HRV 指数、4 个频域指数中的 3 个以及 xBRS 均与肝脂肪含量呈负相关（均 P<0.05），而 1 型糖尿病患者则没有。
在新发 2 型糖尿病患者中，较低的心脏迷走神经张力和压力感受性反射敏感性与普遍存在的肝脂肪变性密切相关，提示肝脂肪变性在 2 型糖尿病中自主神经病变的早期发展中起作用。
