Combination of Ewing test, heart rate variability, and heart rate turbulence analysis for early diagnosis of diabetic cardiac autonomic neuropathy.
Combination of Ewing test, heart rate variability, and heart rate turbulence analysis for early diagnosis of diabetic cardiac autonomic neuropathy.
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DOI：
10.1097/md.0000000000008296
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发表时间：
2017-11
期刊：
影响因子：
1.6
通讯作者：
Zeng Q
中科院分区：
文献类型：
--
作者：
Lin K;Wei L;Huang Z;Zeng Q
比较分析Ewing试验、心率变异性（HRV）和心率震荡（HRT）对糖尿病患者心脏自主神经病变（CAN）的诊断价值。研究了90例糖尿病患者（年龄18-78岁）和20例非糖尿病对照组。对所有参与者进行标准Ewing试验和24小时霍尔特以评估CAN。Ewing评分≥2的患者被归类为CAN+。糖尿病组CAN阳性率为44.4%（40/90），对照组为5%（1/20），两组比较差异有统计学意义（P <0.05）。 经HRV分析和HRT分析，糖尿病患者CAN阳性率分别为56.67%（51/90）和52.22%（47/90）。所有正常-正常（NN）间期的SD（SDNN）、整个记录5分钟内计算的平均NN间期的SD（SDANN）、低频功率（LF）和湍流斜率（TS）与Ewing评分呈显著负相关。TS（r =-0.68，P <0.05）和SDNN（r =-0.58，P <0.05）与相关因素中Ewing评分的相关性最强。 将TS与SDNN结合作为CAN的诊断标准，可将诊断灵敏度提高到98%。CAN+组Ewing试验中用于评价副交感神经功能的参数、HR变异性和HR震荡显著降低。SDNN与TS联合应用的诊断价值高于Ewing试验、HRV分析或HRT分析。
The aim of this study was to compare and analyze Ewing test, heart rate variability (HRV), and heart rate turbulence (HRT) in the diagnosis of cardiac autonomic neuropathy (CAN) in diabetic patients. Ninety diabetic patients (age 18–78) and 20 nondiabetic control subjects were studied. Standard Ewing test and 24-hour Holter was performed in all participants to evaluate CAN. Patients with Ewing score ≥2 were classified as CAN+. The rate of CAN+ in diabetic patients [44.4% (40/90)] was higher than that in the controls [5% (1/20)] (P < .05). Using the HRV analysis and HRT analysis, rates of CAN+ in diabetic patients were 56.67% (51/90) and 52.22% (47/90), respectively. SD of all normal-to-normal (NN) intervals (SDNN), SD of the average NN intervals calculated over 5-minute periods of the entire recording (SDANN), low frequency power (LF), and turbulence slope (TS) were significantly correlated negatively with Ewing scores. TS (r = −0.68, P < .05) and SDNN (r = −0.58, P < .05) had the strongest correlation with Ewing scores among relevant factors. Combining TS with SDNN as diagnostic criteria for CAN, the diagnostic sensitivity can be increased to 98%. Parameters used for evaluating parasympathetic functions in Ewing test, HR variability, and HR turbulence were found to significantly decrease in CAN+ group. The combination of SDNN and TS showed greater diagnostic value than Ewing test, HRV analysis, or HRT analysis alone.