Tang Tiantian, Sun Xinyu, Zhang Xiaoxiang, Li Jiaojiao, Wang Manjie, Hui Cancan, Cheng Yuwei, Kong Xiaoming, Sun Yan
Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Front Endocrinol (Lausanne). 2025 Apr 30;16:1556345. doi: 10.3389/fendo.2025.1556345. eCollection 2025.
To analyze the risk factors for decreased heart rate variability (HRV) in elderly diabetic patients and evaluate the predictive value of 25-hydroxyvitamin D [25-(OH)D].
A retrospective study was conducted, enrolling 101 elderly diabetic patients admitted to the Department of Geriatric Endocrinology at the First Affiliated Hospital of Anhui Medical University from 2023 to 2024. Patients were divided into two groups based on the standard deviation of all normal RR intervals (SDNN) from 24-hour Holter monitoring: the normal HRV group (180 ms ≥ SDNN ≥ 100 ms) and the decreased HRV group (SDNN < 100 ms). Clinical data collected included age, sex, body mass index (BMI), Diabetic peripheral neuropathy (DPN), Diabetic peripheral vascular disease (DPVD), Diabetic nephropathy (DN), Diabetic retinopathy (DR), as well as laboratory parameters such as fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), creatinine (Cr), glomerular filtration rate (GFR), uric acid (UA), cystatin C (CysC), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C), non-HDL-C, 25-(OH)D, 24-hour urinary total protein (24hUTP), 24-hour urinary uric acid (24hUA), microalbuminuria (MAlb), urinary albumin-to-creatinine ratio (UACR), and calculated ratios including TG/HDL-C, UA/HDL-C, and non-HDL-C/HDL-C. Statistical analyses included χ² test, independent -test, Mann-Whitney U test, and multivariate logistic regression to identify risk factors for HRV reduction. Receiver operating characteristic () curve analysis was performed to assess the predictive value of these factors.
Compared with the normal HRV group, the decreased HRV group had significantly lower HDL-C and 25-(OH)D levels but higher prevalence of DN, along with elevated 24hUTP, MAlb, UACR, TG/HDL-C, and UA/HDL-C (all P < 0.05). These factors were identified as independent risk factors for HRV reduction in elderly diabetic patients.
This study identified key risk factors for HRV reduction in elderly diabetic patients. Furthermore, 25-(OH)D levels may serve as an early predictive marker for decreased HRV in this population.
分析老年糖尿病患者心率变异性（HRV）降低的危险因素，并评估25-羟基维生素D[25-(OH)D]的预测价值。
进行一项回顾性研究，纳入2023年至2024年安徽医科大学第一附属医院老年内分泌科收治的101例老年糖尿病患者。根据24小时动态心电图监测的所有正常RR间期标准差（SDNN）将患者分为两组：HRV正常组（180 ms≥SDNN≥100 ms）和HRV降低组（SDNN<100 ms）。收集的临床资料包括年龄、性别、体重指数（BMI）、糖尿病周围神经病变（DPN）、糖尿病周围血管疾病（DPVD）、糖尿病肾病（DN）、糖尿病视网膜病变（DR），以及实验室参数，如空腹血糖（FPG）、糖化血红蛋白（HbA1c）、肌酐（Cr）、肾小球滤过率（GFR）、尿酸（UA）、胱抑素C（CysC）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、极低密度脂蛋白胆固醇（VLDL-C）、非HDL-C、25-(OH)D、24小时尿总蛋白（24hUTP）、24小时尿尿酸（24hUA）、微量白蛋白尿（MAlb）、尿白蛋白与肌酐比值（UACR），以及计算得出的比值，包括TG/HDL-C、UA/HDL-C和非HDL-C/HDL-C。统计分析包括χ²检验、独立样本t检验、Mann-Whitney U检验和多因素逻辑回归，以确定HRV降低的危险因素。绘制受试者工作特征（ROC）曲线分析，以评估这些因素的预测价值。
与HRV正常组相比，HRV降低组的HDL-C和25-(OH)D水平显著降低，但DN患病率更高，同时24hUTP、MAlb、UACR、TG/HDL-C和UA/HDL-C升高（均P<0.05）。这些因素被确定为老年糖尿病患者HRV降低的独立危险因素。
本研究确定了老年糖尿病患者HRV降低的关键危险因素。此外，25-(OH)D水平可能作为该人群HRV降低的早期预测指标。
