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目的观察动态心率震荡(TD)这一新指标在老年糖尿病患者中的变化及其与传统高危预测指标“心率震荡(HRT)和心率变异”的相关性。方法选择45例有室性早搏的老年糖尿病患者(糖尿病组)与45例有室性早搏的非器质性心脏病患者(对照组)接受24小时动态心电图检查,分别计算:心率震荡的震荡初始值(TO)、震荡斜率(TS)、动态心率震荡(TD)及心率变异性时域指标(SDNN)、平均心率,比较两组各指标的差异及相关性。结果糖尿病组TO明显高于对照组,TS和TD低于对照组;糖尿病组各指标相关性分析显示,年龄与平均心率与TO正相关,与TS负相关;TO与SDNN呈负相关,TS与SDNN呈正相关;TO与TS呈负相关;而TD与年龄、平均心率、SDNN均无显著相关性(p>0.05)。结论糖尿病组HRT明显减弱,TD、TS值变化更显著,只有TD检测时不受年龄、平均心率等其他因素的影响,具有相对独立性,可提供更客观预测价值,动态心率震荡(TD)可作为老年糖尿病患者自主神经损害评估的又一项新的高效预测指标。
Objective To observe the changes of the new index of dynamic heart rate turbulence (TD) in elderly patients with diabetes mellitus and its relationship with the traditional high-risk predictors of heart rate turbulence (HRT) and heart rate variability. Methods Forty-five elderly patients with diabetes mellitus (DM) with premature ventricular contractions and 45 non-structural heart disease patients with premature ventricular contractions (control group) underwent 24-hour ambulatory electrocardiogram (ECG) TO, TS, TD and SDNN, mean heart rate were measured and compared between the two groups. Results Compared with control group, TO and TD in diabetic group were significantly lower than those in control group. Correlation analysis showed that age and mean heart rate were positively correlated with TO and negatively correlated with TS; TO and SDNN were negatively correlated with TS and SDNN was positively correlated; TO was negatively correlated with TS; while TD had no significant correlation with age, mean heart rate and SDNN (p> 0.05). Conclusion The HRT of diabetic group was obviously weakened, the TD and TS values were more obvious. Only TD was independent of age, average heart rate and other factors, which provided more objective predictive value. TD (dynamic heart rate turbulence) As a new and highly predictive indicator of autonomic nerve damage in elderly patients with diabetes.