心率变异性在糖尿病肾病透析患者中的研究分析(1)
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【摘要】目的 评价透析对于糖尿病与非糖尿病慢性肾功能不全患者在心率变异性(HRV)上作用。方法 按是否患有糖尿病将纳入患者分为A(糖尿病组)、B(非糖尿病组)两组，在未开始规律透析前均行24 h 动态心电图(HOLTER)检查及血红蛋白、肾小球滤过率、血浆白蛋白、电解质水平监测，比较AB两组在HRV上的差异性。待患者GFR逐渐下降至<15mmHg，并开始规律血透>3月后再次测量HRV，比较各组透析前后HRV是否有区别。结果 在未开始规律透析前，A组的患者Mean RR、SDNN、SDANN/5 min较B组均更低；开始规律透析3月后，A组患者仅有SDANN/5 min有所改善，而B组患者则SDNN、SDANN/5 min均提高。结论 患有糖尿病的CKD4期患者有更严重的自主神经受损，透析后，HRV指标的改善对终末期肾病患者生存及预后的改变有积极意义。
中图分类号：R587.2文献标识码：A文章编号：1005-0515(2010)12-022-03
【Abstract】Objective Heart rate variability (HRV) is related to autonomic nervous system disturbance. The aim of this study was to examine the effect of chronic haemodialysis therapy on HRV in diabetic and non-diabetic patients with chronic kidney disease (CKD). Methods We studied 15 patients with stage 4 CKD and type 2 diabetes mellitus (A group), 15 patients with stage 4 CKD without diabetes (B group), The study was performed in two phases. In the first phase, a 24-h Holter electrocardiographic (ECG) monitoring was performed in all subjects. Then the patients were followed up until they progressed to stage 5 CKD, and in the second phase of the study, they underwent a 24-h Holter ECG monitoring after completion of 3monthsof conventional haemodialysis treatment. Results In the first phase of the study, a worse autonomicfunction in CKD4+DMpatients (significantly lower SDNN, SDANN/5 min, SD, VLFand LF/HF) vs B group’s patients. After 3 months of dialysismtherapy, the patients in A group showed a significant improvement only in the time-domain parameter SDANN/5 min, while the time-domain parameters SDNN, SDANN/5 min and SD were improved in CKD patients without diabetes.Conclusions CKD patients with diabetes is associated with worse cardiac autonomic function. Haemodialysis therapy for 3 months improves some indices of HRV, and this effect is more pronounced in non-diabetic subjects. Our findings suggest that the improvement of HRV after the initiation of chronic dialysis therapy can ameliorate clinical outcomes and survival in patients with end-stage renal disease.
【Keywords】diabetes mellitus; end-stage renal disease; heart rate variability; haemodialysis
心率变异性(HRV)分析是检测心脏自主神经调节功能, 反映交感神经、副交感神经张力及平衡的无创性指标, 已广泛应用于多种心脏疾病的预后判断[1] ......
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