脑小血管病合并2型糖尿病对患者心率变异性影响的相关性分析

Impact of Cerebral Small Vessel Disease with Type 2 Diabetes on Heart Rate Variability: A Correlation Analysis

摘要: 目的：探讨心率变异性(HRV)与2型糖尿病患者脑小血管病(CSVD)影像总负荷之间的关联。方法：本研究连续性纳入2019年1月至2022年10月于青岛大学附属医院住院治疗且出院诊断为2型糖尿病的患者，共146例。依据脑小血管病(CSVD)影像总负荷评分结果，将患者分为两组：低负荷组(评分0~2分，n = 98)和高负荷组(评分3~4分，n = 48)。分析比较两组间的一般临床基线资料及心率变异性参数。进一步采用多因素Logistic回归模型探讨HRV参数与2型糖尿病患者CSVD影像总负荷的关联性，并运用Spearman秩相关分析评估HRV各指标与CSVD总负荷评分的相关性。结果：在脑小血管病(CSVD)影像总负荷评分为3~4分的高负荷组中，患者的年龄与糖尿病病程均显著高于0~2分的低负荷组(P < 0.05)。同时，高负荷组在多项心率变异性(HRV)指标上表现出明显降低，包括所有NN间期的标准差(SDNN)、连续5分钟内所有NN间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(rMSSD)、相邻间期差值 > 50 ms的百分比(PNN50)、低频功率(LF)及高频功率(HF)，差异均具有统计学意义(P < 0.05)。两组间的低频与高频功率比值(LF/HF)比较未见显著差异(P > 0.05)。多因素Logistic回归分析表明，SDNN (OR = 0.925, 95% CI: 0.863~0.983, P = 0.011)和SDANN (OR = 0.913, 95% CI: 0.863~0.965, P = 0.001)是2型糖尿病患者CSVD影像总负荷的独立影响因素。Spearman相关性分析进一步显示，SDNN、SDANN、rMSSD、PNN50、LF及HF均与CSVD影像总负荷评分呈显著负相关(P < 0.05)。结论：心率变异性(HRV)的降低是2型糖尿病患者发生脑小血管病(CSVD)影像总负荷增加事件的独立危险因素。此外，HRV各项指标与CSVD影像总负荷之间均呈现显著的负相关关系。

Abstract: Objective: Investigation of the Association between Heart Rate Variability and the Total Neuroimaging Burden of Cerebral Small Vessel Disease in Patients with Type 2 Diabetes Mellitus. Methods: A total of 146 patients with a discharge diagnosis of type 2 diabetes were consecutively enrolled from the Affiliated Hospital of Qingdao University between January 2019 and October 2022. Based on the total neuroimaging burden score of cerebral small vessel disease (CSVD), patients were stratified into two groups: a low-burden group (score 0~2, n = 98) and a high-burden group (score 3~4, n = 48). General clinical characteristics and heart rate variability (HRV) parameters were compared between the two groups. Multivariable logistic regression analysis was employed to examine the relationship between HRV and the total CSVD imaging burden in patients with type 2 diabetes. Additionally, Spearman’s rank correlation analysis was conducted to assess the correlation between HRV indices and the total CSVD burden score. Results: Compared to the low-burden group (score 0~2), the high-burden group (score 3~4) exhibited significantly higher age and longer duration of diabetes (P < 0.05). Furthermore, the high-burden group demonstrated significantly lower values in several heart rate variability (HRV) parameters, including Standard Deviation of NN intervals (SDNN), Standard Deviation of the Averages of NN intervals in all 5-minute segments (SDANN), Root Mean Square of Successive Differences (rMSSD), Percentage of NN50 (pNN50), Low Frequency Power (LF), and High Frequency Power (HF) (all P < 0.05). No statistically significant difference was observed in the LF/HF ratio between the two groups (P > 0.05). Multivariable logistic regression analysis identified SDNN (OR = 0.925, 95% CI: 0.863~0.983, P = 0.011) and SDANN (OR = 0.913, 95% CI: 0.863~0.965, P = 0.001) as independent influencing factors for the total CSVD imaging burden in middle-aged and elderly patients with type 2 diabetes. Spearman’s correlation analysis further revealed that SDNN, SDANN, rMSSD, PNN50, LF, and HF were all significantly negatively correlated with the total CSVD burden score (all P < 0.05). Conclusions: Decreased heart rate variability (HRV) serves as an independent risk factor for the development of an increased total imaging burden of cerebral small vessel disease (CSVD) in patients with type 2 diabetes. Furthermore, all HRV parameters demonstrate a significant negative correlation with the total CSVD imaging burden.