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目的:初步探讨2型糖尿病(T2DM)合并高血压患者心率减速力(DC)的变化与不同类型高血压的临床相关性和预警价值。方法:采集163例T2DM合并高血压患者根据血压监测诊断情况分为四组:T2DM血压正常组,T2DM合并单纯收缩期高血压(ISH)组,合并单纯舒张期高血压(IDH)组,合并收缩期-舒张期双期高血压(SDH)组。分别对各组患者进行24 h动态血压及动态心电图检测,再离线对24 h心动周期进行PRSA处理,计算心率减速力(DC)、心率变异性(HRV)时域指标并分析比较。结果:较单纯T2DM组,其余各组的DC及HRV各时域指标均降低,差异均有统计学意义(P<0.05);T2DM+IDH组的DC值在猝死高危值、猝死中危值的发生率明显高于其它组,差异均有统计学意义(P<0.05);结论:不同类型高血压均可加重2型糖尿病患者DC、HRV的降低程度,增加猝死风险;且单纯舒张期高血压(IDH)与DC、HRV协同变化最明显,预示糖尿病人群合并该亚型者猝死风险更大。
Objective: To investigate the clinical relevance and early warning value of changes of heart rate deceleration (DC) in patients with type 2 diabetes mellitus (T2DM) complicated with hypertension and different types of hypertension. Methods: One hundred and sixty-three T2DM patients with hypertension were divided into four groups according to their blood pressure monitoring and diagnosis: T2DM normotensive group, T2DM with isolated systolic hypertension (ISH) group and simple diastolic hypertension (IDH) group with systolic Stage - diastolic double-phase hypertension (SDH) group. The 24 h ambulatory blood pressure and ambulatory electrocardiogram (ECG) were performed in each group. PRSA treatment was performed on the 24 h cardiac cycle offline, and the time domain indexes of heart rate deceleration (DC) and heart rate variability (HRV) were calculated and compared. Results: Compared with simple T2DM group, the DC and HRV indexes in the other groups were significantly decreased (P <0.05). The DC value in T2DM + IDH group was significantly higher than those in T2DM group (P0.05) .Conclusion: Different types of hypertension can exacerbate the reduction of DC and HRV in type 2 diabetic patients and increase the risk of sudden death. The incidence of simple diastolic hypertension (IDH) and DC, HRV co-ordination of the most obvious change, indicating that diabetic patients with this subtype of the greater risk of sudden death.