Reduced heart rate variability among youth with type 1 diabetes: the SEARCH CVD study.
Reduced heart rate variability among youth with type 1 diabetes: the SEARCH CVD study.
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DOI：
10.2337/dc12-0463
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发表时间：
2013-01
期刊：
影响因子：
16.2
通讯作者：
Dabelea D
中科院分区：
文献类型：
--
作者：
Jaiswal M;Urbina EM;Wadwa RP;Talton JW;D'Agostino RB Jr;Hamman RF;Fingerlin TE;Daniels S;Marcovina SM;Dolan LM;Dabelea D
这项研究比较了患有和不患有1型糖尿病的年轻人的心率变异性(HRV)参数，并探索了HRV改变的潜在因素。对354例1型糖尿病青年(平均年龄18.8岁，糖尿病病程9.8年，平均糖化血红蛋白8.9%)和176例非糖尿病青年(平均年龄19.2岁)进行了心率变异性参数的测量。在调整协变量后，使用多元线性回归来评估糖尿病状态与HRV参数之间的关系。与对照组相比，青年1型糖尿病患者总体心率变异性降低(NN间期标准差降低10.09ms[SDNN])，副交感神经丢失标志物减少(13.5ms减少NN间期均方根连续差[RMSSD]和5.2归一化单位(N.U))。降低高频功率)，具有交感超驰(5.2 N.U。增加的低频功率)，与人口统计学、人体测量学和传统的心血管危险因素无关。年龄较大、女性、较高的低密度脂蛋白胆固醇和甘油三酯水平以及微量白蛋白尿的存在独立地与较低的HRV相关，但不能解释观察到的患有和不患有糖尿病的年轻人之间的差异。患有1型糖尿病且A1C水平≥为7.5%的年轻人的心率变异性参数显著低于对照组；然而，血糖控制最佳的年轻人(A1C和A1C水平为7.5%)的心率变异参数与对照组无显著差异。青年1型糖尿病患者有早期心脏自主神经病变的迹象：总体心率变异性降低，副交感神经丧失，交感神经优先。这些亚临床异常的主要驱动因素似乎是高血糖。
This study compared heart rate variability (HRV) parameters in youth with and without type 1 diabetes and explored potential contributors of altered HRV. HRV parameters were measured among 354 youth with type 1 diabetes (mean age 18.8 years, diabetes duration 9.8 years, and mean A1C 8.9%) and 176 youth without diabetes (mean age 19.2 years) participating in the SEARCH CVD study. Multiple linear regression was used to assess the relationship between diabetes status and HRV parameters, adjusting for covariates. Compared with control subjects, youth with type 1 diabetes had reduced overall HRV (10.09 ms lower SD of NN intervals [SDNN]) and markers of parasympathetic loss (13.5 ms reduced root mean square successive difference of NN intervals [RMSSD] and 5.2 normalized units (n.u.) reduced high frequency [HF] power) with sympathetic override (5.2 n.u. increased low frequency [LF] power), independent of demographic, anthropometric, and traditional cardiovascular risk factors. Older age, female sex, higher LDL cholesterol and triglyceride levels, and presence of microalbuminuria were independently associated with lower HRV but did not account for the observed differences between youth with and without diabetes. Youth with type 1 diabetes and A1C levels ≥7.5% had significantly worse HRV parameters than control subjects; however, in youth with optimal glycemic control (A1C <7.5%), HRV parameters did not differ significantly from control subjects. Youth with type 1 diabetes have signs of early cardiac autonomic neuropathy: reduced overall HRV and parasympathetic loss with sympathetic override. The main driver of these subclinical abnormalities appears to be hyperglycemia.