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中国全科医学

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2型糖尿病患者心率变异性与脑梗死的相关性研究

徐君, 张劼*   

  1. 315000浙江省宁波市，宁波市第二医院内分泌代谢科
  • 收稿日期:2025-02-13 修回日期:2025-03-31 接受日期:2025-04-23
  • 通讯作者: 张劼
  • 基金资助:
    2023年宁波市国际合作项目(2023H024); 浙江省医药卫生科技计划项目(2021KY1012)

The Relationship between Heart Rate Variability and Ischemic Stroke in Patients with Type 2 Diabetes

XU Jun, ZHANG Jie*   

  1. Department of endocrinology and metabolism, Ningbo No.2 Hospital, Ningbo 315000, China
  • Received:2025-02-13 Revised:2025-03-31 Accepted:2025-04-23
  • Contact: ZHANG Jie
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摘要： 背景　心率变异率（heart rate variability，HRV）与脑梗死发生相关。然而，在2型糖尿病患者中，关于HRV与脑梗死的关系的研究尚少。目的 探讨2型糖尿病患者HRV与脑梗死的关系。方法　选取宁波市第二医院住院的577例2型糖尿病患者，根据患者有无脑梗死分为脑梗死组和无脑梗死组。收集患者病史和一般资料、实验室检查结果。患者进行24h动态心电图监测，HRV参数包括正常间隔到正常间隔的标准差（standard deviation of all normal to normal intervals，SDNN）、相邻RR间期之差的均方根值（root mean square differences of successive RR intervals，rMSSD）和相邻RR间期相差>50 ms的数量占总心搏数的百分比（the percent of adjacent RR intervals with a difference greater than 50 ms，PNN50）。采用t检验、χ2检验或Mann-Whitney U检验对两组指标进行比较，Logistic回归分析HRV与脑梗死的关系。将HRV参数SDNN分为减低组（SDNN < 100 ms）与正常组（SDNN ≥ 100 ms）两组，分析其与脑梗死的关系。结果　共纳入577例2型糖尿病患者，脑梗死组287例，无脑梗死组290例。两组患者在年龄、高血压占比、体重指数、总胆固醇、高密度脂蛋白胆固醇、SDNN、rMSSD和PNN50上的差异有统计学意义（P<0.05）。logistic回归分析结果显示，SDNN水平减低是脑梗死的发生密切相关[OR(95% CI)为0.970(0.961~0.979)，P<0.05]，SDNN 在减低组发生脑梗死的风险较正常组更高[OR(95% CI)为4.164(2.769~6.262)，P<0.05]。结论　2型糖尿病患者中HRV参数减低与脑梗死相关，随着SDNN减低，患者发生脑梗死的风险增高。

关键词: 2型糖尿病, 脑梗死, 心率变异率, 正常间隔到正常间隔的标准差

Abstract: Background　Previous studies have found that heart rate variability（HRV）is associated with cerebral infarction. However this relationship in patients with type 2 diabetes has been less well studied. Objective　To explore the relationship between HRV and cerebral infarction in patients with type 2 diabetes. Methods　A total of 577 patients with type 2 diabetes were selected from Ningbo No.2 Hospital。According to the presence or absence of cerebral infarction, patients were divided into cerebral infarction group and non-cerebral infarction group. The medical history, general data and laboratory results were collected. All patients received 24-hour Holter monitoring. HRV parameters include the standard deviation of all normal to normal intervals (SDNN), the root mean square differences of successive RR intervals(rMSSD）,the percent of adjacent RR intervals with a difference greater than 50 ms (PNN50). Comparisons of variables between two groups were made using Student′s ttest, χ2 test or Mann-Whitney U test. Logistic regression analysis was used to analyze the relationship between HRV and cerebral infarction. Logistic regression was performed to further analyze the relationship while SDNN was divided into < 100 ms（declined HRV group）and ≥ 100 ms（normal HRV group）.Results　A total of 577 patients with type 2 diabetes were enrolled. There were 287cases in cerebral infarction group and 290 cases in non-cerebral infarction group. There were statistically significant differences in age distribution, hypertension history, body mass index, total cholesterol, high density lipoprotein-cholesterol, SDNN, rMSSD and PNN50 between cerebral infarction group and non-cerebral infarction group（P<0.05）. Logistic regression analysis showed that the decrease of SDNN was closely related to the increase of cerebral infarction [OR(95% CI) was 0.970(0.961~0.979)，P<0.05] and the risk of cerebral infarction in the declined HRV group was higher than that in the normal HRV group [OR(95% CI) was 4.164(2.769~6.262)，P<0.05]. Conclusions　The reduction of HRV parameters in patients with type 2 diabetes was closely related to cerebral infarction. With the reduction of SDNN, the risk of patients with cerebral infarction increased.

Key words: Type 2 diabetes mellitus, Ischemic stroke, Heart rate variability, Standard deviation of all normal to normal intervals

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