2型糖尿病患者血压昼夜节律变化与空腹血糖、心率变异性的相关性研究

A Study on the Relationship between Dynamic Changes in Blood Pressure and Heart Rate Variability in Patients with Type 2 Diabetes

摘要: 目的：监测2型糖尿病(T2DM)患者血压昼夜节律、空腹血糖(FBG)、心率变异性的变化，探讨血压昼夜节律变化与FBG和心率变异性的关系。方法：采用1:1倾向性评分匹配法选取2021年5月至2022年5月于青岛大学附属医院收治的82例T2DM患者，根据夜间收缩压下降率(SBPF)分为杓型组(10%~20%, n = 41)和非杓型组(低于10%，n = 41)，监测24 h动脉血压、24 h动态心电图，检测FBG、糖化血红蛋白(HbA1c)、血肌酐(Cr)等水平，利用统计学方法分析血压昼夜节律改变与FBG、心率变异性参数的相关性。结果：杓型组nSBP、nDBP、24 h SBP、24 h DBP、FBG水平和24 h MHR显著低于非杓型组。SDNN、SDANN、RMSSD以及PNN50水平显著高于非杓型组(P < 0.05)；SBPF与FBG和24 h MHR水平呈负相关。SBPF与SDNN、SDANN、RMSSD以及PNN50呈正相关(P < 0.05)。结论：T2DM患者SBPF与FBG、心率变异性参数有关，关注患者的SBPF有助于改善患者血糖水平并预防并发症。

Abstract: Objective: To monitor the changes of blood pressure circadian rhythm, fasting blood glucose (FBG) and heart rate variability in patients with type 2 diabetes (T2DM), and explore the relationship between the changes of blood pressure circadian rhythm and FBG and heart rate variability. Meth-ods: Eighty-two patients with T2DM admitted to Qingdao University Affiliated Hospital from May 2021 to May 2022 were selected using a 1:1 propensity score matching method, and they were di-vided into arytenoid group (10%~20%, n = 41) and non-arytenoid group (less than 10%, n = 41) according to the nocturnal systolic blood pressure drop rate (SBPF). All enrolled patients were monitored for 24-hour arterial blood pressure, 24-hour dynamic electrocardiogram, and levels of FBG, glycated hemoglobin (HbA1c), and blood creatinine (Cr) were measured. Statistical methods were used to analyze the correlation between changes in blood pressure circadian rhythm and FBG and heart rate variability parameters. Results: nSBP, nDBP, 24 h SBP, 24 h DBP, FBG levels and 24 h MHR were significantly lower in the arytenoid group than in the non-arytenoid group. nSBP, SDANN, RMSSD and PPN50 levels were significantly higher than in the non-arytenoid group (P < 0.05); SBPF was negatively correlated with FBG and 24 h MHR levels. nSBP was negatively correlated with SDNN, SDANN, RMSSD and PPN50 levels. nSBP, SDANN, RMSSD and PPN50 levels were significantly higher than in the non-arytenoid group. RMSSD and PNN50 were positively correlated (P < 0.05). Conclusion: SBPF in T2DM patients is related to FBG and heart rate variability parameters, and paying attention to patients’ SBPF can help improve their blood glucose levels and prevent compli-cations.