糖尿病心脏自主神经病变、心率变异性与IL-1、IL-6、TNF-α的相关性研究

发布时间：2018-05-13 11:58

  本文选题：2型糖尿病 + 心脏自主神经病变　； 参考：《天津医科大学》2017年硕士论文

【摘要】：目的:1.探讨糖尿病性心脏自主神经病变(DCAN)和心率变异性(HRV)的特点。2.探讨血清IL-1、IL-6、TNF-α水平对DCAN发病风险的影响。3.探讨DCAN的影响因素,为探讨DCAN的发病机制提供一定基础。方法:1.收集资料:试验组(DM组)选取2013年9月-2014年4月于天津医科大学代谢病医院神经内科住院治疗的T2DM患者124例,对照组(NC组)选取健康查体者49例。收集所有受试者的一般临床资料、空腹静脉血检测生化指标、酶联免疫法测量血清人白细胞介素1(IL-1)、人白细胞介素6(IL-6)、人肿瘤坏死因子α(TNF-α),并根据公式HOMA-IR=FPG×FINS/22.5计算胰岛素抵抗指数。2.所有接受试验者给予24小时全导动态心电图分析检测,取得HRV指标。根据所得HRV指标,其中DM组HRV异常受试者69例,为DCAN组,正常者55例,为NDCAN组。3.应用单因素方差分析、卡方检验比较DM组与NC组之间以及NC组、DCAN组与NDCAN组之间的一般资料,IL-1、IL-6、TNF-α、HRV各项指标,以及进行IL-1、IL-6、TNF-α与HRV各项指标相关分析,多因素二元Logistic回归分析DCAN影响因素。结果:1.IL-1与年龄、病程、SBP、BMI、WHR、HbA1c、FPG、UMA水平正相关,与SDNN、SDANN、LF、HF、LF(NORM)呈负相关;IL-6和TNF-α均与年龄、病程、BMI、WHR、Hb A1c、FPG、Cr、UMA水平正相关,与e GFR、SDNN、SDANN、LF、HF、LF(NORM)、LF/HF均呈负相关(P0.05);2.DCAN组在年龄、BMI、WHR、FPG、Hb A1c、UMA、LDL、e GFR方面高于NC组,NDCAN组在年龄、BMI、WHR、FPG、Hb A1c、UMA、e GFR方面高于NC组,DCAN组在UMA、糖尿病病程、DR、DKD患病率方面高于NDCAN组,差异有统计学意义(P0.05);3.DCAN组在IL-1、IL-6、TNF-α浓度方面高于NC和NDCAN组,NDCAN组在IL-6、TNF-α浓度方面高于NC组,差异有统计学意义(P0.05);4.DCAN组在SDNN、SDANN、LF、HF、LF(norm)、LF/HF方面低于NC组,NDCAN组在SDNN、SDANN、RMSSD、LF、HF、LF(norm)、HF(norm)、LF/HF方面低于NC组,DCAN组在SDNN、SDANN、RMSSD、LF、HF、LF(norm)、HF(norm)方面低于NDCAN组,差异有统计学意义(P0.05);5.经多因素多元logistic回归显示病程、UMA、IL-1、IL-6、TNF-α为DCAN的危险因素,SDNN为DCAN的保护因素;6.UMA的三分位数将所有数据分为3组,由低到高依次为UMA1、UMA2、UMA3,发现三组间血清IL-1、IL-6、TNF-α浓度呈上升趋势,SDNN、SDANN、RMSSD、LF、HF、LF(norm)、LF/HF呈降低趋势,差异均有统计学意义(P0.05)。7.分别将IL-1、IL-6、TNF-α以四分位数分组,由低到高顺序分为1-4组,血清IL-1、IL-6、TNF-α水平随受试者年龄、DM病程、Hb A1c、FPG的逐渐增加而升高,而SDNN、SDANN、LF、HF、LF(norm)呈降低趋势,差异均有统计学意义(P0.05)。结论:1.炎症因子IL-1、IL-6、TNF-α与DCAN的发病密切相关。2.DCAN组的HRV指标普遍呈下降趋势,而HF(norm)可能更早于其他指标出现下降。3.病程、UMA、IL-1、IL-6、TNF-α为DCAN的危险因素,SDNN为DCAN的保护因素。4.DCAN与T2DM微血管并发症存在着相关性,且炎症因子IL-1、IL-6、TNF-α与DKD的发病密切相关。
[Abstract]:Purpose 1. To investigate the characteristics of diabetic cardiac autonomic neuropathy (DCAN) and heart rate variability (HRV). Objective: to investigate the effect of serum IL-1, IL-6 and TNF- 伪 levels on the risk of DCAN. To explore the influencing factors of DCAN and to provide a basis for exploring the pathogenesis of DCAN. Method 1: 1. Data collected: the experimental group (DM group) selected 124 T2DM patients who were hospitalized in the Department of Neurology, Metabolic Disease Hospital of Tianjin Medical University from September 2013 to April 2014, and the control group (NC group) selected 49 healthy examiners. The general clinical data of all subjects were collected, the biochemical indexes were detected in fasting venous blood, the serum levels of human interleukin 1 (IL 1), human interleukin 6 (IL 6) and human tumor necrosis factor 伪 (TNF- 伪) were measured by enzyme linked immunosorbent assay (Elisa). The insulin resistance index (IRI) was calculated according to the formula HOMA-IR=FPG 脳 FINS/22.5. All the subjects were given 24-hour ambulatory electrocardiogram analysis to obtain HRV. According to the obtained HRV indexes, 69 subjects with abnormal HRV in DM group were in DCAN group, 55 cases in normal group, and 3. 3 in NDCAN group. Univariate analysis of variance (ANOVA) and chi-square test were used to compare the general data between DM group and NC group, and between NC group and Dcan group, and between NC group and NDCAN group, as well as the correlation analysis between IL-1and IL-6TNF- 伪 and HRV. Multivariate Logistic regression analysis was used to analyze the influencing factors of DCAN. Results: 1. IL-1 was positively correlated with age, course of disease, and the level of HbA1cFPGUMA, but negatively correlated with SDNNs (SDANN), IL-6, TNF- 伪 and age, and the level of BMI-WHRHbA1cFPGUMA was negatively correlated with the level of CRUMA. There was a negative correlation between the age of BMIWHH and the age of BMIWH-RFPGG HbA1cU GFR in the age group compared with the NC group. The prevalence of GFR in the age group was higher than that in the NC group. The prevalence rate of DKD was higher in the age group than that in the group of the NC group in the age group of BMIWHWHRHbA1cUMA-E, and the prevalence rate of the disease course of diabetes was higher than that of the group of NDCAN in the age of BMIWHR, the prevalence rate of DKD was higher than that of the group of NDCAN in the age of BMIWHR, the prevalence rate of DMD was higher than that in the group of NC-DCAN, the prevalence of DKD was higher in the age group than that in the group of NC. 宸�寮傛湁缁熻�″�︽剰涔�(P0.05);3.DCAN缁勫湪IL-1,IL-6,TNF-伪娴撳害鏂归潰楂樹簬NC鍜孨DCAN缁，

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