Department of Endocrinology, Key Laboratory of Endocrinology of the National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
PLoS One. 2018 Oct 3;13(10):e0204804. doi: 10.1371/journal.pone.0204804. eCollection 2018.
Cardiac autonomic neuropathy is a common but always overlooked. More convenient diagnostic methods are needed.
Cardiac autonomic neuropathy risk score evaluated by SUDOSCAN has a fine diagnostic efficacy detecting cardiac autonomic neuropathy.
This is a cross-sectional study among patients with diabetes mellitus. Subjects undertook SUDOSCAN tests and cardiac autonomic reflex tests, including heart rate variability due to Valsalva maneuver, heart rate response due to deep breathing and heart rate response due to standing up. Presenting 2 abnormal results was defined as cardiac autonomic neuropathy.
Subjects with cardiac autonomic neuropathy has significantly higher cardiac autonomic neuropathy risk score (32.88±1.60 vs 27.64±1.24,P = 0.010). Cardiac autonomic neuropathy risk score was correlated significantly with the heart rate response due to deep breathing(P = 0.004). Multiple regression analysis including significant variables showed an independent association of cardiac autonomic neuropathy risk score and heart rate response due to deep breathing (P = 0.031) and age (P = 0.000). In receiver operating characteristic curve analysis evaluating the relationship between cardiac autonomic neuropathy risk score and cardiac autonomic neuropathy, The cut-off value was 20.5, with the sensitivity of 90.48%, the specificity of 29.5%, and the positive predictive value of 46.9%. In two-step diagnostic methods, Setting 20.5 as the cut-off value of cardiac autonomic neuropathy risk score and abnormal heart rate response due to standing up as the second diagnostic step's positive result, and setting 16.5 as the cut-off value of cardiac autonomic neuropathy risk score and abnormal heart rate response due to deep breathing as the second diagnostic step's positive result, both achieved good diagnostic efficacy.
Cardiac autonomic neuropathy risk score evaluated by SUDOSCAN is a good screening test for cardiac autonomic neuropathy. The two-step diagnostic methods could be considered as surrogate diagnostic methods.
心脏自主神经病变是一种常见但常常被忽视的疾病。需要更方便的诊断方法。
通过 SUDOSCAN 评估的心脏自主神经病变风险评分具有良好的诊断心脏自主神经病变的效果。
这是一项糖尿病患者的横断面研究。受试者进行了 SUDOSCAN 测试和心脏自主反射测试，包括瓦尔萨尔瓦动作引起的心率变异性、深呼吸引起的心率反应和站立引起的心率反应。出现 2 项异常结果定义为心脏自主神经病变。
心脏自主神经病变患者的心脏自主神经病变风险评分显著升高（32.88±1.60 比 27.64±1.24，P = 0.010）。心脏自主神经病变风险评分与深呼吸引起的心率反应显著相关（P = 0.004）。包括显著变量的多元回归分析显示，心脏自主神经病变风险评分与深呼吸引起的心率反应（P = 0.031）和年龄（P = 0.000）独立相关。在评估心脏自主神经病变风险评分与心脏自主神经病变之间关系的受试者工作特征曲线分析中，截断值为 20.5，敏感性为 90.48%，特异性为 29.5%，阳性预测值为 46.9%。在两步诊断方法中，将 20.5 作为心脏自主神经病变风险评分的截断值，将站立时异常心率反应作为第二步诊断的阳性结果，将 16.5 作为心脏自主神经病变风险评分的截断值，将深呼吸时异常心率反应作为第二步诊断的阳性结果，两种方法均具有良好的诊断效果。
通过 SUDOSCAN 评估的心脏自主神经病变风险评分是心脏自主神经病变的一种良好筛查试验。两步诊断方法可作为替代诊断方法。
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