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目的探讨2型糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,DCAN)的临床特征及相关危险因素。方法纳入2012年2月至2013年1月在广东省人民医院内分泌科就诊的2型糖尿病患者47例(按1999年世界卫生组织建议的糖尿病诊断标准),所有2型糖尿病患者进行葡萄糖耐量试验(OGTT)、胰岛素释放试验、血脂等分析,并以Ewing试验作为诊断DCAN的标准,对DCAN的患病情况、临床特征及可能的主要危险因素进行分析。同时,招募糖耐量正常者19例设为正常对照组。结果以Ewing试验为标准诊断心脏自主神经病变(cardiac autonomic neuropathy,CAN),正常对照组CAN的患病率仅为5.3%(1/19),2型糖尿病组为55.3%(26/47),两组比较差异有统计学意义(P=0.001)。2型糖尿病组中病程≤5年患者的DCAN患病率为45.2%(14/31),>5年患者为75.0%(12/16),两者比较差异有统计学意义(P=0.051)。2型糖尿病组中DCAN患者心率、收缩压、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、尿酸与正常对照组患者比较,差异有统计学意义(P<0.05)。静息心率>80次/min、收缩压>140 mm Hg(1 mm Hg=0.133 kPa)、空腹胰岛素>100 pmol/L、胰岛素抵抗指数>5.3或胰岛素分泌指数>102.65、尿酸>350μmol/L的患者的DCAN患病率均较正明显增加,均差异有统计学意义(P<0.05)。Logistic回归分析显示,糖化血红蛋白(HbA1c)(OR=11.788)、胰岛素抵抗指数(OR=17.211)、尿酸(OR=5.757)是DCAN的主要独立危险因素。结论 2型糖尿病患者是CAN的高危人群;糖化血红蛋白、胰岛素抵抗指数、尿酸是DCAN的主要独立危险因素。
Objective To investigate the clinical features and related risk factors of type 2 diabetes mellitus autonomic neuropathy (DCAN). Methods Forty-seven patients with type 2 diabetes (recommended by the World Health Organization in 1999) were enrolled in Department of Endocrinology, Guangdong Provincial People’s Hospital from February 2012 to January 2013. All patients with type 2 diabetes underwent glucose tolerance test OGTT), insulin release test and lipids analysis. The Ewing test was used as the diagnostic criteria for DCAN. The prevalence, clinical features and possible major risk factors of DCAN were analyzed. Meanwhile, 19 patients with normal glucose tolerance were recruited as normal control group. Results Ewing test was used to diagnose cardiac autonomic neuropathy (CAN). The prevalence of CAN in the normal control group was only 5.3% (1/19) and that in the type 2 diabetes mellitus was 55.3% (26/47) The difference between the two groups was statistically significant (P = 0.001). The prevalence of DCAN was 45.2% (14/31) in patients with type 2 diabetes ≤ 5 years and 75.0% (12/16) in> 5 years, the difference was statistically significant (P 0.051) . The heart rate, systolic blood pressure, fasting insulin, insulin resistance index (HOMA-IR), insulin secretion index (HOMA-β) and uric acid in DCAN patients in type 2 diabetes group were significantly different from those in normal control group ). Resting heart rate> 80 beats / min, systolic blood pressure> 140 mm Hg (1 mm Hg = 0.133 kPa), fasting insulin> 100 pmol / L, insulin resistance index> 5.3 or insulin secretion index> 102.65, uric acid> 350 μmol / L The prevalence of DCAN in both groups was significantly higher than that of the control group, with statistical significance (P <0.05). Logistic regression analysis showed that HbA1c (OR = 11.788), insulin resistance index (OR = 17.211) and uric acid (OR = 5.757) were the main independent risk factors for DCAN. Conclusions Type 2 diabetes is a high risk population of CAN. Glycated hemoglobin, insulin resistance index and uric acid are the main independent risk factors for DCAN.