心血管自主神经病变预测2型糖尿病患者复发性心血管疾病的临床研究-现代医学

心血管自主神经病变预测2型糖尿病患者复发性心血管疾病的临床研究

单位：江汉大学附属医院(武汉市第六医院) 内分泌科, 湖北武汉 430015

分类号：R587

出版年·卷·期（页码）：2017·36·第八期（1100-1105）

摘要：

目的：探讨心血管自主神经病变（CAN）对2型糖尿病（T2DM）患者复发性心血管疾病（CVD）的预测价值。方法：回顾性分析2000年1月~2005年12月来我院接受治疗的T2DM患者70例。根据患者CVD有无复发分为CVD复发组（n=30）和CVD未复发组（n=40）。对所有T2DM患者进行CAN筛查，比较两组在临床资料及实验室检查方面的差异，对患者进行10年随访，记录CVD累计发病率。采用COX比例风险回归模型进行影响T2DM患者复发CVD的单因素、多因素分析。结果：与CVD未复发组比较，CVD复发组在高血压病例数、糖尿病肾病例数、尿白蛋白排泄量方面差异显著（P<0.05）；CVD复发组在Valsalva动作指数异常病例数、体态比异常病例数、CAN病变程度方面差异显著（P<0.05）。其中，CVD复发组CAN确诊病变比例显著高于CVD未复发组（P<0.05）。CAN未病变复发性CVD累积危险率< CAN早期病变复发性CVD累积危险率< CAN确诊病变复发性CVD累积危险率（P<0.05）。CAN病变程度（确诊病变）可增加T2DM患者复发性CVD发生的风险（P<0.05）。结论：CVD复发T2DM患者中CAN的比例较高，临床医师应密切关注T2DM患者CAN情况。

Objective: To investigate the predictive value of cardiovascular autonomic neuropathy(CAN)in patients with type 2 diabetes mellitus(T2DM)with recurrent cardiovascular disease(CVD).Methods: 70 cases of T2DM patients receiving treatment in our hospital from Jan 2000 and Dec 2005 were collected and reviewed for retrospective analysis. According to CVD recurrence, the patients were divided into CVD recurrence group(n=30)and no CVD recurrence group(n=40).CAN screening was performed in all patients with T2DM, and the differences between the two groups in clinical data and laboratory examination were compared. The patients were followed up for 10 years, and the cumulative incidence of CVD was recorded. COX proportional hazards regression model was used to analyze the single factor and multi-factor analysis of CVD in patients with T2DM. Results: Compared with the no CVD recurrence group, there were significant differences in the occurrence of hypertension, diabetic nephropathy, urinary albumin excretion(P<0.05)in the CVD recurrence group. There were significant differences in abnormal Valsalva index, abnormal body posture and the degree of CAN in the CVD recurrence group(P<0.05). Among them, confirmed CAN diagnosis rate was significantly higher in CVD recurrence group than that in no CVD recurrence group(P<0.05). CAN could increase the risk of recurrent CVD in patients with T2DM(P<0.05).Conclusion: The proportion of CAN in CVD patients with recurrent T2DM is high, clinicians should pay close attention to CAN in T2DM patients.

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