Effects of sustained insulin-induced hypoglycemia on cardiovascular autonomic regulation in type 1 diabetes
Effects of sustained insulin-induced hypoglycemia on cardiovascular autonomic regulation in type 1 diabetes
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DOI：
10.2337/diabetes.54.3.744
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发表时间：
2005-03-01
期刊：
影响因子：
7.7
通讯作者：
Huikuri, HV
中科院分区：
文献类型：
--
作者：
Koivikko, ML;Salmela, PI;Huikuri, HV
低血糖对心脏自主调节的影响可能导致不良心脏事件的发生。本研究评估了持续高胰岛素血症性低血糖对I型糖尿病患者和非糖尿病患者心血管自主神经调节的影响。该研究包括16名1型糖尿病患者和8名年龄匹配的健康对照受试者，他们以随机顺序接受了正常血糖和低血糖钳夹手术。在三种不同的葡萄糖水平（4.5-5.5、3.0-3.5和2.0-2.5 mmol/l）下，在高胰岛素-正常血糖和低血糖钳夹期间，通过时域和频域方法，沿着Poincare图分析，从连续心电图记录中测量心率变异性。控制性低血糖导致两例糖尿病患者仰卧位心率增加（从72 +/- 9到80 +/- 11 bpm，P < 0.01）和对照组（从59 +/- 5到65 +/- 5 bpm，P < 0.05），高频频谱成分和心跳间心率变异性逐渐降低（SD 1;糖尿病组P < 0.05，对照组P < 0.01）。正常血糖钳夹过程中心率变异性无显著变化。我们的结论是，低血糖导致糖尿病和非糖尿病受试者的心脏迷走神经流出减少。自主神经调节改变可能导致低血糖期间心脏事件的发生。
Effects of hypoglycemia on cardiac autonomic regulation may contribute to the occurrence of adverse cardiac events. This study assessed the effects of sustained hyperinsulinemic hypoglycemia on cardiovascular autonomic regulation in type I diabetic patients and their nondiabetic counterparts. The study consisted of 16 type 1 diabetic patients and 8 age-matched healthy control subjects who underwent euglycemic and hypoglycemic clamp procedures in a random order. Heart rate variability was measured from continuous electrocardiogram recordings by time and frequency domain methods, along with Poincare plot analysis during both a hyperinsulinemic-euglycemic and hypoglycemic clamp at three different glucose levels (4.5-5.5, 3.0-3.5, and 2.0-2.5 mmol/l). Controlled hypoglycemia resulted in an increase of supine heart rate in both the diabetic patients (from 72 +/- 9 to 80 +/- 11 bpm, P < 0.01) and the control subjects (from 59 +/- 5 to 65 +/- 5 bpm, P < 0.05) and progressive reductions of the high-frequency spectral component and beat-to-beat heart rate variability (SD1; P < 0.05 in the diabetic patients and P < 0.01 in control subjects). No significant changes in heart rate variability occurred during the euglycemic clamp. We conclude that hypoglycemia results in a reduction of cardiac vagal outflow in both diabetic and nondiabetic subjects. Altered autonomic regulation may contribute to the occurrence of cardiac events during hypoglycemia.