疑诊冠心病患者糖化血红蛋白与心率变异性的相关性分析(1)
[摘要] 目的 探讨糖化血红蛋白(HbA1c)与心率变异性的关系。 方法 选择2013年10月～2015年2月首都医科大学附属北京天坛医院疑诊冠心病的住院患者82例。所有患者均行HbA1c等常规化验、动态心电图及冠状动脉造影检查。根据HbA1c检测结果将患者分为高HbA1c组(HbA1c>6.5%，24例)和低HbA1c组(HbA1c≤6.5%，58例)，比较两组在生化和心率变异性等指标的差异。 结果 高HbA1c组患者的高血压病比例、收缩压、冠心病比例、糖尿病比例、空腹血糖、三酰甘油明显高于低HbA1c组(P < 0.05)。与低HbA1c组比较，高HbA1c组心率变异三角指数(TI)明显降低，全部窦性心搏RR间期的标准差<100 ms的患者比例明显增加(P < 0.01)。Pearson相关分析显示，TI与HbA1c、收缩压呈负相关(r = -0.307，P < 0.01；r = -0.234，P < 0.05)。多元逐步回归显示，校正其他因素后TI与HbA1c独立相关(P < 0.01)。 结论 HbA1c与心率变异性呈负相关，是心率变异性降低的独立危险因素。
[关键词] 糖化血红蛋白；心率变异性；冠心病；相关性
[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210(2016)06(c)-0072-04
[Abstract] Objective To investigate the relationship between hemoglobin A1c (HbA1c) and heart rate variability in patients with suspected coronary artery disease. Methods The 82 inpatients with suspected coronary artery disease were recruited at Department of Cardiology， Beijing Tiantan Hospital from October 2013 to February 2015. The HbA1c and other biochemical parameters， ambulatory electrocardiography， and coronary angiography were performed. Patients were divided into the two groups according to the HbA1c： higher HbA1c group (HbA1c >6.5%， 24 patients) and lower HbA1c group (HbA1c ≤6.5%， 58 patients). The biochemical parameters and heart rate variability were compared between the two groups. Results The patients in higher HbA1c group showed a higher prevalence of hypertension， diabetes mellitus and coronary artery disease， higher systolic blood pressure， blood glucose and triglycerides. Compared with those in lower HbA1c group (P < 0.05). As compared with patients in the lower HbA1c group， patients in higher HbA1c group had lower Tri index (TI) and higher proportion of patiets with standard deviation of NN intervals (SDNN)<100 ms (P < 0.01). Pearson correlation analysis found that， TI was negatively associated with HbA1c and systolic blood pressure (r = -0.307， P < 0.01； r = -0.234， P < 0.05). Multiple linear regression found that， HbA1c was an independent risk factor for decreased TI after adjustment for confounders (P < 0.01). Conclusion HbA1c is negatively associated with TI， and is an independent risk factor for decreased heart rate variability.
[Key words] Hemoglobin A1c； Heart rate variability； Coronary artery disease； Correlation
研究显示，高血糖是心血管疾病的“连续危险因子”[1-2]。良好的血糖控制是预防糖尿病相关心脑血管并发症的关键。糖化血红蛋白(hemoglobin A1c，HbA1c)可反映检测前2～3个月患者的平均血糖水平，不受饮食、应激等因素的影响，是判定糖尿病患者血糖控制好坏的“金标准”。心率变异性(heart rate variability，HRV)是指心动周期中心率的变异，是反映交感神经和副交感神经间平衡的重要指标。研究表明HRV与心脏猝死等有密切关系[3-5]，还有研究显示，糖尿病患者HbA1c与HRV呈负相关，HbA1c是糖尿病患者不良心脑血管事件发生的危险因素[6-7]。然而，目前关于疑诊冠心病患者HbA1c与HRV的研究甚少。因此，本研究旨在探讨疑诊冠心病患者HbA1c与HRV的相关性。 (王鸿 田俊萍 于洋 王意忠)
[关键词] 糖化血红蛋白；心率变异性；冠心病；相关性
[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210(2016)06(c)-0072-04
[Abstract] Objective To investigate the relationship between hemoglobin A1c (HbA1c) and heart rate variability in patients with suspected coronary artery disease. Methods The 82 inpatients with suspected coronary artery disease were recruited at Department of Cardiology， Beijing Tiantan Hospital from October 2013 to February 2015. The HbA1c and other biochemical parameters， ambulatory electrocardiography， and coronary angiography were performed. Patients were divided into the two groups according to the HbA1c： higher HbA1c group (HbA1c >6.5%， 24 patients) and lower HbA1c group (HbA1c ≤6.5%， 58 patients). The biochemical parameters and heart rate variability were compared between the two groups. Results The patients in higher HbA1c group showed a higher prevalence of hypertension， diabetes mellitus and coronary artery disease， higher systolic blood pressure， blood glucose and triglycerides. Compared with those in lower HbA1c group (P < 0.05). As compared with patients in the lower HbA1c group， patients in higher HbA1c group had lower Tri index (TI) and higher proportion of patiets with standard deviation of NN intervals (SDNN)<100 ms (P < 0.01). Pearson correlation analysis found that， TI was negatively associated with HbA1c and systolic blood pressure (r = -0.307， P < 0.01； r = -0.234， P < 0.05). Multiple linear regression found that， HbA1c was an independent risk factor for decreased TI after adjustment for confounders (P < 0.01). Conclusion HbA1c is negatively associated with TI， and is an independent risk factor for decreased heart rate variability.
[Key words] Hemoglobin A1c； Heart rate variability； Coronary artery disease； Correlation
研究显示，高血糖是心血管疾病的“连续危险因子”[1-2]。良好的血糖控制是预防糖尿病相关心脑血管并发症的关键。糖化血红蛋白(hemoglobin A1c，HbA1c)可反映检测前2～3个月患者的平均血糖水平，不受饮食、应激等因素的影响，是判定糖尿病患者血糖控制好坏的“金标准”。心率变异性(heart rate variability，HRV)是指心动周期中心率的变异，是反映交感神经和副交感神经间平衡的重要指标。研究表明HRV与心脏猝死等有密切关系[3-5]，还有研究显示，糖尿病患者HbA1c与HRV呈负相关，HbA1c是糖尿病患者不良心脑血管事件发生的危险因素[6-7]。然而，目前关于疑诊冠心病患者HbA1c与HRV的研究甚少。因此，本研究旨在探讨疑诊冠心病患者HbA1c与HRV的相关性。 (王鸿 田俊萍 于洋 王意忠)