Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy
Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy
复制标题
DOI：
10.2337/diacare.29.02.06.dc05-1242
复制
发表时间：
2006-02-01
期刊：
影响因子：
16.2
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Astrup, AS;Tarnow, U;Parving, HH
目的-心脏自主神经病变（CAN）与糖尿病患者的不良预后有关.由于CAN在糖尿病肾病患者中很常见，我们评估了CAN在1型糖尿病患者中的预测价值，包括糖尿病肾病和非糖尿病肾病。对197例1型糖尿病合并糖尿病肾病患者和191例长期1型糖尿病伴正常白蛋白尿患者进行10.1年随访（范围0.0 - 10.3年）。在基线时，通过深呼吸期间的心率变异性（HRV）评估CAN。心率变异性被评估为主要终点的预测因子：心血管发病率和死亡率。作为次要终点，全因死亡率和HRV对糖尿病肾病进展（肾小球滤过率[GFR]下降）的影响进行了评估。结果-在随访期间，79例（40%）肾病患者达到了联合主要终点，而1.9例（10%）正常白蛋白尿患者（对数秩检验，P < 0.0001）。当HRV异常时，达到主要终点的未校正风险比（HR）（
OBJECTIVE - Cardiac autonomic neuropathy (CAN) has been associated with a poor prognosis in patients with diabetes. Because CAN is common in patients with diabetic nephropathy, we evaluated the predictive value of CAN in type 1 diabetic patients with and without diabetic nephropathy.RESEARCH DESIGN AND METHODS - in a prospective observational follow-up study, 197 type 1 diabetic patients with diabetic nephropathy and a matched group of 191 patients with long-standing type 1 diabetes and normoalbuminuria were followed for 10.1 years (range 0.0 - 10.3 years). At baseline, CAN was assessed by heart rate variation (HRV) during deep breathing. HRV was evaluated as a predictor of the primary end point: cardiovascular morbidity and mortality. As secondary end points, all-cause mortality and the influence of HRV on progression of diabetic nephropathy (decline in glomerular filtration rate [GFR]) was evaluated.RESULTS - During the follow-up, 79 patients (40%) with nephropathy reached the combined primary end point vs. 1.9 patients (10%) with normoalbuminuria (log-rank test, P < 0.0001). The unadjusted hazard ratio (HR) for reaching the primary end point when having an abnormal HRV (