2型糖尿病患者静息心率与糖尿病肾病的相关性研究
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摘要
目的:
通过观察2型糖尿病患者尿微量白蛋白(microaount albmin of urine,MAU)和静息心率(resting heart rate ,RHR)的变化,研究静息心率与糖尿病肾脏损害的相关性,说明静息心率对糖尿病肾病发生、发展的促进作用。初步探讨糖尿病自主神经病变在糖尿病肾病(diabetic nephropathy,DN)发生、发展中的作用。
方法:
选取我院2009年10月至2011年2月于门诊就诊和住院的2型糖尿病患者77例,糖尿病诊断标准按1999年我国采用的美国糖尿病协会(ADA)规定,标准为空腹静脉血血浆血糖大于7.0mmol/L,同期选取在我院健康体检中心的健康体检者45例,作为对照组。所有入选对象在入选前均进行一次全面查体并详细记录,通过详细询问病史及必要的检查排除原发性高血压,甲状腺疾病,急性感染,原发肾病,输尿管疾病,急性代谢紊乱,心律失常,风湿免疫病等。所有患者均为初诊或停用影响心率药物5天以上。糖尿病组根据尿白蛋白测定分为三组:单纯白蛋白尿组(MAU﹤20 mg/l),微量白蛋白尿组(20 mg/l≦MAU≦200mg/l),大量白蛋白尿组(MAU>200mg/l)。记录其病程、年龄、性别、体重指数,同时检测糖脂代谢指标。所有受试者均于安静环境下休息10分钟用12导联心电图机记录心电图,并取Ⅱ导联作为描记对象,记录10个心动周期(RR),根据RR计算平均心动周期,用平均心动周期计算静息心率(RHR),比较各组间静息心率的变化。采用SPSS13.0进行资料的统计学分析,计量资料以x±S表示,计数资料用例数或率表示。计数资料间的差异比较采用χ2。检验水准α=0.05,P值均取双侧概率。
结果:
(1)2型糖尿病患者组与正常对照组的BMI、MAU、Ccr、BUN、血糖、TG、TC、SBP、DBP差别有统计学意义(P﹤0.05)。
(2)2型糖尿病患者组与正常对照组的RHR差别有统计学意义(P﹤0.05)。
(3)2型糖尿病患者尿微量白蛋白与病程、血压、RHR、内生肌酐清除率均相关,糖尿病患者病程越长,静息心率值越大,则糖尿病患者尿微量白蛋白值越大。
结论:
(1)2型糖尿病患者静息心率加快,RHR的增快可能与交感神经系统自主性功能失调有关。
(2)病程、静息心率与尿微量白蛋白密切相关,静息心率增快是促进糖尿病肾病损害的危险因素。
Objective:
To observe the resting heart rate and microalbuminuria in patients with type 2 diabetes. To study the association of resting heart rate and microalbuminuria. To investigate the promotion of resting heart rate on kidney damage in patients with type 2 diabetes.
Methods:
77 patients with type 2 diabetes who were diagnosed according to the diabetes diagnostic criteria were selected in out-patient clinic of our hospital. The criteria was adopted in china in 1999 by the American Diabetes Association (ADA) requirements. That was the fasting blood glucose is more than 7.0 mmol/L. At the same time, 45 normal cases were selected in physical examination center of our hospital. All the objects were excluded if they had complications like primary hypertension, thyroid disease, acute infections, primary kidney and ureter disease, et al. All patients were newly diagnosed or stopped drugs that affected heart rate more than 5 days. The information contained the duration of diabetes, gender, body mass index, fasting blood glucose and resting heart rate, et al. All date was analyzed in SPSS 13.0. All statistical tests were two sided withαof 0.05.
Results:
(1) There were significant differences between diabetic group and the control group in BMI, MAU, Ccr, BUN, glucose, TC, SBP, DBP(P<0.05).
(2) There were significant differences between diabetic group and the control group in RHR.
(3) The lever of MAU was correlated with diabetic duration, BP, RHR, Ccr; According to regression analysis, the longer duration of diabetes was, the greater value of MAU was. The faster of resting heart rate was.
Conclusion:
(1) Type 2 diabetic clients had faster RHR, which maybe associated with autonomy of the sympathetic nervous system dysfunction.
(2) Resting heart rate is a damage factors on the development of damage on diabetic nephropathy.
通过观察2型糖尿病患者尿微量白蛋白(microaount albmin of urine,MAU)和静息心率(resting heart rate ,RHR)的变化,研究静息心率与糖尿病肾脏损害的相关性,说明静息心率对糖尿病肾病发生、发展的促进作用。初步探讨糖尿病自主神经病变在糖尿病肾病(diabetic nephropathy,DN)发生、发展中的作用。
方法:
选取我院2009年10月至2011年2月于门诊就诊和住院的2型糖尿病患者77例,糖尿病诊断标准按1999年我国采用的美国糖尿病协会(ADA)规定,标准为空腹静脉血血浆血糖大于7.0mmol/L,同期选取在我院健康体检中心的健康体检者45例,作为对照组。所有入选对象在入选前均进行一次全面查体并详细记录,通过详细询问病史及必要的检查排除原发性高血压,甲状腺疾病,急性感染,原发肾病,输尿管疾病,急性代谢紊乱,心律失常,风湿免疫病等。所有患者均为初诊或停用影响心率药物5天以上。糖尿病组根据尿白蛋白测定分为三组:单纯白蛋白尿组(MAU﹤20 mg/l),微量白蛋白尿组(20 mg/l≦MAU≦200mg/l),大量白蛋白尿组(MAU>200mg/l)。记录其病程、年龄、性别、体重指数,同时检测糖脂代谢指标。所有受试者均于安静环境下休息10分钟用12导联心电图机记录心电图,并取Ⅱ导联作为描记对象,记录10个心动周期(RR),根据RR计算平均心动周期,用平均心动周期计算静息心率(RHR),比较各组间静息心率的变化。采用SPSS13.0进行资料的统计学分析,计量资料以x±S表示,计数资料用例数或率表示。计数资料间的差异比较采用χ2。检验水准α=0.05,P值均取双侧概率。
结果:
(1)2型糖尿病患者组与正常对照组的BMI、MAU、Ccr、BUN、血糖、TG、TC、SBP、DBP差别有统计学意义(P﹤0.05)。
(2)2型糖尿病患者组与正常对照组的RHR差别有统计学意义(P﹤0.05)。
(3)2型糖尿病患者尿微量白蛋白与病程、血压、RHR、内生肌酐清除率均相关,糖尿病患者病程越长,静息心率值越大,则糖尿病患者尿微量白蛋白值越大。
结论:
(1)2型糖尿病患者静息心率加快,RHR的增快可能与交感神经系统自主性功能失调有关。
(2)病程、静息心率与尿微量白蛋白密切相关,静息心率增快是促进糖尿病肾病损害的危险因素。
Objective:
To observe the resting heart rate and microalbuminuria in patients with type 2 diabetes. To study the association of resting heart rate and microalbuminuria. To investigate the promotion of resting heart rate on kidney damage in patients with type 2 diabetes.
Methods:
77 patients with type 2 diabetes who were diagnosed according to the diabetes diagnostic criteria were selected in out-patient clinic of our hospital. The criteria was adopted in china in 1999 by the American Diabetes Association (ADA) requirements. That was the fasting blood glucose is more than 7.0 mmol/L. At the same time, 45 normal cases were selected in physical examination center of our hospital. All the objects were excluded if they had complications like primary hypertension, thyroid disease, acute infections, primary kidney and ureter disease, et al. All patients were newly diagnosed or stopped drugs that affected heart rate more than 5 days. The information contained the duration of diabetes, gender, body mass index, fasting blood glucose and resting heart rate, et al. All date was analyzed in SPSS 13.0. All statistical tests were two sided withαof 0.05.
Results:
(1) There were significant differences between diabetic group and the control group in BMI, MAU, Ccr, BUN, glucose, TC, SBP, DBP(P<0.05).
(2) There were significant differences between diabetic group and the control group in RHR.
(3) The lever of MAU was correlated with diabetic duration, BP, RHR, Ccr; According to regression analysis, the longer duration of diabetes was, the greater value of MAU was. The faster of resting heart rate was.
Conclusion:
(1) Type 2 diabetic clients had faster RHR, which maybe associated with autonomy of the sympathetic nervous system dysfunction.
(2) Resting heart rate is a damage factors on the development of damage on diabetic nephropathy.
引文
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[2]Ander AK, Christiansen JS, et al. Diabetic nephropathy in Type 1(insulin-dependent)diabetes: An epidemiological study. Diabetelogia 1983;25:496
[3]刘志红,黎磊石.糖尿病肾病发病机理,[J]中华肾脏病杂志,1999,5
[4] Strojek K, Grzes zczak W, Morawin E, et al. Nephropathy of type 2 diabetes: evidences for hereditary factors[J] Kidney int, 51:1602
[5]朱小刚,心率与心血管疾病相关性的研究现状,[J]Molecular Cardiology of China, Octobor2006,Vol 6 No.5:292-294
[6]汪文杰,孙黎明,静息心率与靶器官损害关系的研究进展,[J]中国老年学杂志,2020,5.
[7]Tlchikubo O, Mizushima S, Watanabe J, et al. Base heart rate during sleep in hypertensive and no imotensive subjects [J].J Hypertens, 2001,19:1131-1137
[8]黎雅清,2型糖尿病心率变异度与糖尿病肾病的关系.暨南大学硕士学位论文,2005,5.
[9]Kinugasa H, Hirayznagik. Effect of skin surface cooling and heating on autonomic nervous activity and baroceflex sensitivity in humans, Exp physical , 1999,84(2):369-377
[10]霍丽,彭永德.微量白蛋白尿与糖尿病心血管病变关系探讨[J].医药专论,2010,31(2):65-67
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[13]Moran A, Palmas W, Field L , Bhattarai J, et al. Cardiovascular Autonomic Neuropathy Is Associated With Microalbuminuria in Older Patients With Type 2 Diabetes. Diabetes. Diabetes Care JD, 2004, 27(4): 972-977
[14]Meinhold JA, Maslowska-Wessel E, Bender R, et al.Low prevslence of cardiac autonomic neuropathy in Type 1 diabetic patients without nephtopathy. [J]Diabet Med, 2001,18(8):603-613
[15]王海燕主编.肾脏病学[M].第二版,北京:人民卫生出版社,1987:16-17.
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[2]Ander AK, Christiansen JS, et al. Diabetic nephropathy in Type 1(insulin-dependent)diabetes: An epidemiological study. Diabetelogia 1983;25:496
[3]刘志红,黎磊石.糖尿病肾病发病机理,[J]中华肾脏病杂志,1999,5
[4] Strojek K, Grzes zczak W, Morawin E, et al. Nephropathy of type 2 diabetes: evidences for hereditary factors[J] Kidney int, 51:1602
[5]朱小刚,心率与心血管疾病相关性的研究现状,[J]Molecular Cardiology of China, Octobor2006,Vol 6 No.5:292-294
[6]汪文杰,孙黎明,静息心率与靶器官损害关系的研究进展,[J]中国老年学杂志,2020,5.
[7]Tlchikubo O, Mizushima S, Watanabe J, et al. Base heart rate during sleep in hypertensive and no imotensive subjects [J].J Hypertens, 2001,19:1131-1137
[8]黎雅清,2型糖尿病心率变异度与糖尿病肾病的关系.暨南大学硕士学位论文,2005,5.
[9]Kinugasa H, Hirayznagik. Effect of skin surface cooling and heating on autonomic nervous activity and baroceflex sensitivity in humans, Exp physical , 1999,84(2):369-377
[10]霍丽,彭永德.微量白蛋白尿与糖尿病心血管病变关系探讨[J].医药专论,2010,31(2):65-67
[11] Matsuoka H. Protective role of renal nerves in the development of diatetic nephropathy[J].Diabetes Res 1993,23:19
[12] Moran A, Palmas W, Field L , et al.. Cardiovascular Autonomic Neuropathy Is Associated With Microalbuminuria in Older Patients With Type 2 Diabetes. Diabetes. Diabetes Care JD, 2004, 27(4): 972-977
[13] Carnethon MR, Yan L, Greenland P, et al. Resting heart tate in middle age and diahetes development in older age [J].Dabetes Care, 2008,31(2):335-339.
[14]Setettle C, Bearth A, Allemann S, et al. QTC interal and resting heart tate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus:a 23-year follow-up [J] Diabetologia,2007,50(1):186-194
[15]Meinhold JA, Maslowska-Wessel E, Bender R, et al.. Low prevslence of cardiac autonomic neuropathy in Type 1 diabetic patients without nephtopathy. Diabet Med,2001,18(8):603-613
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