2型糖尿病患者冠脉病变程度与超氧化物歧化酶及心率变异性的关系

Relationship between Coronary Artery Lesion and Superoxide Dismutase and Heart Rate Variability in Patients with Type 2 Diabetes Mellitus

摘要: 目的：探讨2型糖尿病合并冠心病患者冠脉病变程度与超氧化物歧化酶(SOD)及心率变异性(HRV)的关系。方法：回顾性分析我院住院行冠脉造影患者共219例，并根据冠脉造影结果、既往史及血糖情况分为冠心病合并糖尿病组(CHD + T2DM组)77例、冠心病组(CHD组)89例及正常对照组(CK组)53例。对入选对象的冠脉造影结果进行Gensini评分，测定糖化血红蛋白(HbA1c)、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、空腹血糖(FBG)、SOD等生化指标，记录各组患者24 h动态心电图HRV指标，进行统计学分析。结果：CHD组和CHD + T2DM组年龄、男性比例、吸烟比例、合并高血压比例明显增加，LDL、Gensini评分明显升高，CHD + T2DM组Gensini评分更高；HDL、SOD及HRV明显降低，CHD + T2DM组更低。Gensini评分与FBG (R = 0.28)、HbA1c呈正相关(R = 0.15)，与SOD (R = −0.49)、SDNN (R = −0.46)、SDANN (R = −0.50)、RMSSD (R = −0.34)、PNN50 (R = −0.14)、LF (R = −0.15)呈负相关；SOD与SDNN (R = 0.29)、SDANN (R = 0.25)、RMSSD (R = 0.17)、LF (R = 0.17)呈正相关，与FBG (R = −0.23)、HbA1c (R = −0.22)呈负相关。在CHD + T2DM组行多元线性回归研究构建线性方程Y = 154.27 − 0.51(SOD) − 0.46(SDNN) + 5.17(TG)。ROC曲线分析：SOD/SDNN、SOD/SDANN、SOD/PNN50均对诊断冠心病有意义，其中SOD/SDNN意义最大。结论：冠心病患者SOD及HRV均降低，2型糖尿病使其进一步加重，联合检测血清SOD值及HRV变化尤其是SDNN变化对冠心病的诊断以及2型糖尿病合并冠心病患者冠脉病变严重程度评估有重要意义。

Abstract: Objective: To investigate the relationship between the severity of coronary artery disease and su-peroxide dismutase (SOD) and heart rate variability (HRV) in patients with type 2 diabetes mellitus complicated with coronary heart disease. Methods: A total of 219 patients who underwent coronary angiography in our hospital were retrospectively analyzed. According to the results of coronary angiography, past history and blood glucose, they are divided into CHD + T2DM group (77 cases), CHD group (89 cases) and normal control group (53 cases). Gensini score is used to evaluate the results of coronary angiography. Biochemical indexes such as glycosylated hemoglobin (HbA1c), cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), fasting blood glucose (FBG) and SOD are measured. 24 h Holter HRV indexes of patients in each group are recorded for statistical analysis. Results: In CHD and CHD + T2DM group, age, male proportion, smoking proportion and hypertension proportion are significantly increased, LDL and Gensini scores are significantly increased, Gensini score is higher in CHD + T2DM group, HDL, SOD and HRV are significantly decreased, and lower in CHD + T2DM group. Gensini score is positively correlated with FBG and HbA1c, and negatively correlated with SOD and HRV; SOD is positively correlated with HRV, and negatively correlated with FBG and HbA1c. In CHD + T2DM group, all factors and Gensini score are analyzed by multiple linear regression, and the multiple linear regression equation Y = 154.27 − 0.51 (SOD) − 0.46 (SDNN) + 5.17 (TG) was constructed. ROC curve analysis: SOD/SDNN, SOD/SDANN, SOD/pNN50 are of significance in the diagnosis of coronary heart disease, and SOD/SDNN is the most significant. Conclusion: SOD and HRV decreased in patients with coronary heart disease, which is further aggravated by type 2 diabetes mellitus. Combined detection of serum SOD and HRV, especially SDNN, is of great significance in the diagnosis of coronary heart disease and the evaluation of coronary artery disease severity in patients with type 2 diabetes mellitus complicated with coronary heart disease.