心率变异性、心室晚电位及QT离散度对糖尿病患者自主神经功能评定的研究

目的　对心率变异性 (HRV)、QT离散率 (QTd)及心室晚电位 (VLP) 3种方法判定自主神经功能进行比较 ,以期选择一种较为特异、可靠及敏感的方法。方法　 68例 2型糖尿病 (DM)患者分别进行 HRV、QTd及 VLP测定 ,与 33例正常人进行对比分析。结果　 DM患者正常 R-R间期的标准差 (SDNN)显著小于正常人 (P <0 .0 1 ) ,QTd显著大于正常人 (P <0 .0 1 ) ,VLP阳性率明显增高 (P <0 .0 1 )。 VLP阳性组 SDNN明显低于 VLP阴性组 (P <0 .0 0 1 ) ,QTd显著高于 VLP阴性组 (P <0 .0 0 1 ) ;同时具有 SDNN<1 0 0 ms,QTd≥ 50 ms,VLP阳性者占43.9%。结论　 3种方法相比 ,SDNN敏感性及特异性较高 ,可靠性较好 ;VL P特异性较高 ,可靠性较好 ;QTd虽然敏感性高 ,但可靠性差。建议 QTd作为粗筛指标 ,以长程 HRV列入心血管自主神经功能的常规检查 ,而将 VLP与 HRV结合起来作为判断疾病严重程度的指标并进行危险分级

The study of judging autonomic function of diabetes millitus patients by heart rate variability,ventricular late potential and QT dispersion

In this study, the objects are 68 DM patients who were diagnosised correctly, also 33 normal people.Some examination were done for these people including HRV(timing domain and frequency domain) ,QTd and VLP. The results showed that the average of SDNN of DM patients is less than normal people significantly (P<0.01).The average of QTd of DM patients is more than normal people significantly(P<0.01).The positive rate of VLP is increasing than normal(P<0.01).SDNN of VLP positive group is obviously less than VLP negative group (P<0.001),QTd is significantly more than VLP negative group(P<0.001).The patients according with the requirement of SDNN<100ms,QTd≥50ms and VLP positive is 43.94% of all patients.Compared with three methods, the sensitivity,speciability and duplicaton of SDNN is good;the speciability and duplication of VLP is good;though the sensitivity of QTd is high, the duplication is low.