静息和运动后心率变异性对 2 型糖尿病心脏自主神经病变的诊断性能。

Diagnostic performance of resting and post-exercise heart rate variability for detecting cardiac autonomic neuropathy in type 2 diabetes mellitus.

机构信息

Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi 110025, India.

M.A. Ansari Medical Centre, Jamia Millia Islamia (A Central University), New Delhi 110025, India.

出版信息

Auton Neurosci. 2019 Jul;219:53-65. doi: 10.1016/j.autneu.2019.04.003. Epub 2019 Apr 24.

DOI:10.1016/j.autneu.2019.04.003

PMID:31122603

Abstract

BACKGROUND

Post-exercise recovery phase is associated with clustering of various cardiovascular events and, therefore, monitoring of cardiac autonomic control via heart rate variability (HRV) during this phase may allow identification of autonomic alterations that are not evident under resting conditions in type 2 diabetes mellitus (T2DM) patients.

PURPOSE

To investigate and compare the diagnostic performance of resting and post-exercise HRV for detecting cardiac autonomic neuropathy (CAN) in T2DM patients.

METHODS

Forty-two T2DM patients were categorized as CAN-positive and CAN-negative based on standard cardiovascular autonomic reflex tests (CARTs). Short-term resting and post-exercise HRV after a graded exercise test were evaluated for each participant. Diagnostic performance of both resting and post-exercise HRV measures was computed using standard statistical procedures.

RESULTS

Diagnostic testing yielded superior diagnostic performance of post-exercise HRV than resting HRV measures. Root mean square of successive differences (RMSSD) between adjacent R-R intervals (p = 0.01), percentage of consecutive N-N intervals that vary by >50 ms (pNN50) (p = 0.03) and total power (TP) (p = 0.01) were significantly better diagnostic indicators of CAN under post-exercise conditions than at rest. Predictive ability of these post-exercise HRV measures for CAN was maintained after adjusting various clinical confounders to cardiac autonomic function.

CONCLUSION

Post-exercise HRV measures such as TP, RMSSD and pNN50 were found to be more accurate diagnostic tests for detecting CAN than resting HRV. Hence, monitoring of the HRV measures proposed here during exercise testing protocols may provide important diagnostic information regarding CAN in T2DM.

摘要

背景

运动后恢复期与各种心血管事件相关，因此，在该阶段通过心率变异性（HRV）监测心脏自主神经控制，可能有助于识别 2 型糖尿病（T2DM）患者在静息状态下不明显的自主神经改变。

目的

研究和比较静息和运动后 HRV 对 T2DM 患者检测心脏自主神经病变（CAN）的诊断性能。

方法

根据标准心血管自主反射测试（CART），将 42 名 T2DM 患者分为 CAN 阳性和 CAN 阴性。对每位参与者进行分级运动试验后的短期静息和运动后 HRV 评估。使用标准统计程序计算两种静息和运动后 HRV 测量的诊断性能。

结果

与静息 HRV 测量相比，运动后 HRV 的诊断测试具有更高的诊断性能。相邻 R-R 间期之间的均方根差（RMSSD）（p=0.01）、连续 N-N 间期中差异大于 50ms 的百分比（pNN50）（p=0.03）和总功率（TP）（p=0.01）在运动后条件下是检测 CAN 的更好的诊断指标。在调整各种临床混杂因素对心脏自主神经功能的影响后，这些运动后 HRV 指标对 CAN 的预测能力仍然保持。