糖尿病患者QT离散度与自主神经功能障碍之间的关联

Association between QT dispersion and autonomic dysfunction in patients with diabetes mellitus.

作者信息

Wei K, Dorian P, Newman D, Langer A

机构信息

Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.

出版信息

J Am Coll Cardiol. 1995 Oct;26(4):859-63. doi: 10.1016/0735-1097(95)00279-8.

DOI:10.1016/0735-1097(95)00279-8

PMID:7560609

Abstract

OBJECTIVES

We hypothesized that QT dispersion would be increased in patients with diabetes mellitus and autonomic dysfunction and that QT dispersion would be related to abnormal iodine-123 (I-123) metaiodobenzylguanidine (MIBG) uptake.

BACKGROUND

Patients with diabetes mellitus and autonomic dysfunction have an increased incidence of sudden death. This event may be due to a sympathetic imbalance causing disturbances of repolarization. QT dispersion has recently been demonstrated to reflect dispersion of ventricular refractoriness and is a marker of arrhythmogenic potential. Uptake of I-123 MIBG is a reliable measure of whether the tissue examined receives sympathetic neuronal innervation.

METHODS

Fifty-one diabetic patients and 11 normal subjects were studied. All patients had clinical evaluation for autonomic dysfunction (defined as at least two abnormal heart rate and blood pressure responses to five validated tests). Rest 12-lead electrocardiograms were recorded for measurement of QT dispersion, defined as the longest QT interval minus the shortest QT interval, and corrected for heart rate using Bazett's formula. Visual and quantitative measurements of I-123 MIBG uptake were performed using I-123 MIBG, and technetium-99m sestamibi uptake was used to assess perfusion.

RESULTS

Thirty-five diabetic patients had autonomic dysfunction. Corrected QT dispersion was significantly greater in the patients than in the normal subjects (p = 0.02). The I-123 MIBG scores were also significantly greater in patients with than without autonomic dysfunction (p = 0.0004) and in normal subjects (p = 0.008). There was no correlation between QT dispersion and I-123 MIBG uptake score (r = 0.006, p = 0.97).

CONCLUSIONS

Diabetic patients with autonomic dysfunction have increased QT dispersion and larger I-123 MIBG uptake defects. This finding suggests that such patients have a greater inhomogeneity of repolarization. The lack of correlation between QT dispersion and I-123 MIBG uptake suggests that these abnormalities are mediated by different mechanisms.

摘要

目的

我们推测糖尿病合并自主神经功能障碍患者的QT离散度会增加，且QT离散度与碘-123（I-123）间碘苄胍（MIBG）摄取异常有关。

背景

糖尿病合并自主神经功能障碍患者猝死发生率增加。该事件可能归因于交感神经失衡导致复极紊乱。最近已证实QT离散度可反映心室复极离散度，是致心律失常潜能的标志物。I-123 MIBG摄取是所检查组织是否接受交感神经支配的可靠指标。

方法

研究了51例糖尿病患者和11例正常受试者。所有患者均进行了自主神经功能障碍的临床评估（定义为对五项有效测试中至少两项心率和血压反应异常）。记录静息12导联心电图以测量QT离散度，定义为最长QT间期减去最短QT间期，并使用Bazett公式校正心率。使用I-123 MIBG对I-123 MIBG摄取进行视觉和定量测量，并使用锝-99m甲氧基异丁基异腈摄取评估灌注。

结果

35例糖尿病患者存在自主神经功能障碍。患者校正后的QT离散度显著高于正常受试者（p = 0.02）。有自主神经功能障碍的患者的I-123 MIBG评分也显著高于无自主神经功能障碍的患者（p = 0.0004）和正常受试者（p = 0.008）。QT离散度与I-123 MIBG摄取评分之间无相关性（r = 0.006，p = 0.97）。