Pagani M, Malfatto G, Pierini S, Casati R, Masu A M, Poli M, Guzzetti S, Lombardi F, Cerutti S, Malliani A
Istituto Ricerche Cardiovascolari, CNR, Milan, Italy.
J Auton Nerv Syst. 1988 Aug;23(2):143-53. doi: 10.1016/0165-1838(88)90078-1.
We studied heart rate variability in 49 uncomplicated diabetics (27 with insulin therapy; 22 with oral hypoglycemic agents) and in 40 age-matched controls. An automatic autoregressive algorithm was used to compute the power spectral density (PSD) of beat by beat RR variability derived from the surface ECG. The PSD contains two major components (a low frequency approximately 0.1 Hz (LF) and a high frequency, respiratory linked, approximately 0.25 Hz (HF] that provide, respectively, quantitative markers of sympathetic and vagal modulatory activities and of their balance. As compared to controls, in diabetics, besides a reduced RR variance at rest (2722 +/- 300 and 1436 +/- 241 ms2, respectively), we observed during passive tilt an altered response of spectral indices of sympathetic activation and vagal withdrawal, suggestive of a complex modification in the neural control activities. In addition, we compared this approach to the commonly used clinical tests score, and observed that the latter provides overall results similar to those obtained with spectral changes induced by tilt (r = 0.42; P less than 0.01). Of potential clinical importance is that the data obtained with spectral analysis appear more thoroughly quantifiable and do not require the active collaboration of the patients.
我们研究了49例无并发症糖尿病患者（27例接受胰岛素治疗；22例接受口服降糖药治疗）以及40例年龄匹配的对照者的心率变异性。采用自动自回归算法计算从体表心电图得出的逐搏RR间期变异性的功率谱密度（PSD）。PSD包含两个主要成分（一个低频约0.1 Hz（LF）和一个高频、与呼吸相关、约0.25 Hz（HF）），它们分别提供交感神经和迷走神经调节活动及其平衡的定量指标。与对照组相比，糖尿病患者除静息时RR间期方差降低（分别为2722±300和1436±241 ms²）外，在被动倾斜期间，我们观察到交感神经激活和迷走神经撤离的频谱指标反应改变，提示神经控制活动存在复杂改变。此外，我们将这种方法与常用的临床测试评分进行比较，观察到后者提供的总体结果与倾斜诱导的频谱变化所获得的结果相似（r = 0.42；P＜0.01）。具有潜在临床重要性的是，通过频谱分析获得的数据似乎更易于全面量化，并且不需要患者的积极配合。
