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目的无创评价老年Ⅱ型糖尿病合并高血压病(T2DM+EH)患者心血管自主神经调节功能受损严重程度。方法单纯老年T2DM患者27例,单纯老年EH患者27例,老年T2DM+EH患者30例,互为对照,进行心率变异性(HRV)、心率震荡(HRT)、Lorenz散点图、血压变异性(BPV)分析。结果 1HRV参数:与T2DM组相比,T2DM+EH组的4个参数均降低,其中NN间期标准差(P<0.05)、相邻NN间期差值超过50ms的心搏数所占百分比(P<0.01)有统计学意义;与EH组相比,4个参数亦降低,除相邻NN间期差值的均方根的P<0.05外,余参数P<0.01。与EH组相比,T2DM组TRI降低(P<0.05)。2HRT参数:与T2DM组相比,T2DM+EH组TS降低(P<0.05);与EH组相比,振荡初始值升高,振荡斜率值降低,且两者均有显著差异(P<0.05);与EH组相比,T2DM组TS升高(P<0.05)。3Lorenz散点图面积:三组均无显著差异。4BPV参数:与T2DM组相比,T2DM+EH组收缩压和舒张压下降率均变小(P<0.05或0.01);与T2DM组相比,EH组的收缩压和舒张压下降率均变小(P<0.01)。结论老年T2DM+EH患者心血管自主神经调节功能受损程度较单纯糖尿病和高血压严重。
Objective To evaluate the severity of cardiovascular autonomic dysfunction in elderly patients with type 2 diabetes mellitus (T2DM + EH). Methods Thirty-seven elderly patients with T2DM, 27 elderly patients with EH and 30 elderly patients with T2DM were enrolled in this study. Heart rate variability (HRV), heart rate turbulence (HRT), Lorenz scattergram, BPV) analysis. Results 1HRV parameters: Compared with T2DM group, all four parameters of T2DM + EH group decreased, including standard deviation of interphase interval (P <0.05), percentage of heart rate with adjacent interphalangeal space difference exceeding 50ms ( P <0.01). Compared with EH group, the four parameters also decreased. Except for the mean square root of the difference between adjacent NNs, P <0.05, the rest parameters P <0.01. Compared with EH group, TRI in T2DM group decreased (P <0.05). 2HRT parameters: The TS of T2DM + EH group was lower than that of T2DM group (P <0.05). Compared with EH group, the initial oscillation value and the oscillation slope decreased, both of which were significantly different (P <0.05) Compared with EH group, the TS of T2DM group increased (P <0.05). 3Lorenz scatter plot area: no significant difference between the three groups. 4BPV parameters: Compared with T2DM group, T2DM + EH group systolic and diastolic blood pressure decreased rate was smaller (P <0.05 or 0.01); compared with T2DM group, EH group decreased systolic and diastolic blood pressure were lower (P <0.01). Conclusions The cardiovascular autonomic nervous system dysfunction in elderly patients with T2DM + EH is worse than that of simple diabetes mellitus and hypertension.