Fujimoto Y, Fukuki M, Hoshio A, Sasaki N, Hamada T, Tanaka Y, Yoshida A, Shigemasa C, Mashiba H
First Department of Internal Medicine, Tottori University Hospital, Yonago, Japan.
Jpn Circ J. 1996 Dec;60(12):925-32. doi: 10.1253/jcj.60.925.
We investigated the characteristics of decreased heart rate variability (HRV) in diabetic patients with ischemic heart disease (IHD). Twenty-one healthy control subjects, 17 diabetic patients without IHD, and 33 diabetic patients with IHD were studied. The diabetic patients with IHD were subdivided into 2 groups according to the severity of their IHD: severe or mild. HRV was evaluated in all subjects using the spectral variables of the all-frequency, low-frequency, high-frequency (AF, LF, HF) components and the LF/HF ratio were determined from Holter recordings. The AF and LF components in patients with diabetes only or diabetes and severe IHD were significantly lower than in control group, but the HF component was significantly lower only in the group of patients with diabetes and severe IHD. The LF/HF ratio did not differ significantly among the 4 groups, but was the lowest in diabetic patients without IHD. Patients with diabetes and mild IHD showed a slight decrease in HRV, but this was not significant. With regard to the circadian rhythm of HRV, the AF and LF components in patients with diabetes-only or diabetes and severe IHD were significantly decreased and showed the same pattern throughout the day. However, the HF component was decreased during more time zones in patients with diabetes and severe IHD, whereas the LF/HF ratio was lower during more time zones in the diabetes-only group. All spectral variables showed a tendency to be inversely related to the duration of diabetes in all diabetic patients. In particular, the LF/HF ratio showed a significant negative correlation. The HRV of diabetic patients was characterized by a decreased LF/HF ratio. It was concluded that, although HRV in diabetic patients with severe IHD was reduced mainly as a result of diabetic neuropathy, this was also partly due to a decline in parasympathetic tone as a result of myocardial injury.
我们研究了患有缺血性心脏病（IHD）的糖尿病患者心率变异性（HRV）降低的特征。研究对象包括21名健康对照者、17名无IHD的糖尿病患者以及33名患有IHD的糖尿病患者。患有IHD的糖尿病患者根据其IHD的严重程度分为两组：重度或轻度。使用全频、低频、高频（AF、LF、HF）成分的频谱变量对所有受试者的HRV进行评估，并根据动态心电图记录确定LF/HF比值。仅患有糖尿病或患有糖尿病和重度IHD的患者的AF和LF成分显著低于对照组，但仅在患有糖尿病和重度IHD的患者组中HF成分显著降低。LF/HF比值在这4组之间无显著差异，但在无IHD的糖尿病患者中最低。患有糖尿病和轻度IHD的患者HRV略有下降，但不显著。关于HRV的昼夜节律，仅患有糖尿病或患有糖尿病和重度IHD的患者的AF和LF成分显著降低，且全天呈现相同模式。然而，患有糖尿病和重度IHD的患者在更多时区HF成分降低，而仅患有糖尿病的患者组在更多时区LF/HF比值更低。所有频谱变量在所有糖尿病患者中均显示出与糖尿病病程呈负相关的趋势。特别是，LF/HF比值显示出显著的负相关。糖尿病患者的HRV特征为LF/HF比值降低。得出的结论是，虽然患有重度IHD的糖尿病患者的HRV降低主要是由于糖尿病神经病变，但这也部分归因于心肌损伤导致的副交感神经张力下降。
