文献类型：期刊文献

中文题名：2型糖尿病患者血清25羟维生素D与心脏自主神经功能相关性的研究

英文题名：Correlation between 25?hydroxyvitamin D and cardiac autonomic nervous function in patients with type 2 diabetes mellitus

作者：马红梅[1];马俊得[2];武振亚[1];王飞茹[3];王丽娟[1];刘胜男[1];汤惠惠[1];杨文[1];王紫琼[1];何文静[1];杨睿斐[4];郭茜[4];王金羊[4]

第一作者：马红梅

机构：[1]甘肃中医药大学第一临床医学院,兰州730000;[2]甘肃省永靖县人民医院;[3]兰州大学第一临床医学院;[4]甘肃省人民医院内分泌科干部病区

第一机构：甘肃中医药大学临床医学院

年份：2025

卷号：33

期号：5

起止页码：321

中文期刊名：中国糖尿病杂志

外文期刊名：Chinese Journal of Diabetes

收录：;北大核心:【北大核心2023】；

基金：国家自然科学基金(81760147、81560143、82360163);甘肃省自然科学基金(21JR1RA013、24JRRA589);甘肃省卫生健康行业科研项目(GSWSQN2024-01);甘肃省人民医院院内科研基金项目(21GSSYYC-15)。

语种：中文

中文关键词：糖尿病,2型;25羟维生素D;心血管自主神经功能;心率变异性

外文关键词：Diabetes mellitus,type 2;25(OH)D;Cardiac autonomic nervous function;Heart rate variability

摘要：目的探讨T2DM患者25羟维生素D[25(OH)D]与心脏自主神经功能的相关性。方法选取2022年10月至2023年10月甘肃省人民医院内分泌科住院治疗的T2DM患者328例,根据血清25(OH)D水平分为<10 ng/ml组(n=80)、10~20 ng/ml组(n=173)及20~30 ng/ml组(n=75)。比较各组生化指标、血钙(Ca^(2+))、血磷(P5+)、25(OH)D、甲状旁腺素(PTH)、β-胶原特殊序列(β-CTX)、骨钙素(OC)、左心室质量(LVM)及左心室质量指数(LVMI),以及患者24 h动态心电图心率变异性(HRV)中时域指标,包括正常窦性RR间期总体标准差(SDNN)、窦性RR间期均值标准差(SDANN)、正常连续窦性RR间期差值均方根(rM SSD)等。同时比较相邻RR间期差值>50 ms占间期总数的百分比(PNN50)、HRV三角指数、全程相邻NN间期长度之差的标准差(SDSD)等24 h动态心电图HRV时域相关指标,分析骨代谢参数对心脏自主神经功能的影响及相互关系。受试者工作特征(ROC)曲线预测心脏自主神经功能的最佳切点。结果10 ng/ml、10~20 ng/ml、20~30 ng/ml组SBP、心率(HR)、FPG、脉搏波传导速度、PTH、β-CTX依次降低(P<0.05),HDL-C、踝肱指数、25(OH)D、Ca^(2+)、P5+、SDNN、SDANN、rM SSD、SDSD、PNN50、HRV三角指数依次升高(P<0.05或P<0.01)。Spearman和Pearson相关分析显示,25(OH)D与SDNN、HRV三角指数、PNN50、rM SSD呈正相关(P<0.01)。Logistic回归分析显示,25(OH)D、Ca^(2+)、HR是T2DM患者心脏自主神经功能障碍的影响因素。ROC曲线分析显示,25(OH)D、Ca^(2+)、HR预测心脏自主神经功能障碍的ROC曲线下面积分别为0.791、0.607、0.629,敏感度分别为73.4%、53.2%、38.7%,特异度分别为74.0%、93.6%、81.4%。结论25(OH)D是T2DM患者心脏自主神经功能障碍的影响因素,其高缺乏的T2DM患者易发生心脏自主神经功能障碍。
Objective To investigate the predictive value of bone metabolism parameters on cardiac autonomic nervous system function in patients with type 2 diabetes mellitus(T2DM).Methods A total of 328 patients with T2DM hospitalized in the Department of Endocrinology of Gansu Provincial People’s Hospital were enrolled in this study from October 2022 to October 2023.According to the serum 25(OH)D level,all the participants were divided into<10 ng/ml group(n=80),10~20 ng/ml group(n=173),and 20~30 ng/ml group(n=75).Biochemical indicators,bone metabolic parameters,left ventricular mass(LVM)and left ventricular mass index(LVMI)were compared.Time domain indicators ofheart rate variability(HRV)in 24 h holter electrocardiogram,including the global standard deviation of normal sinus RR interval(SDNN),sinus RR interval mean standard deviation(SDANN),and normal continuous sinus RR interval difference root mean square(RMSSD).Meanwhile,adjacent RR interval difference>50 ms as a percentage of the total inter-period(PNN50),HRV triangle index,standard deviation of the difference between the length of the entire adjacent NN interperiod(SDSD),and 24 h holter electrocardiogram HRV time-domain relevant indicators were compared among the three groups.The influence of bone metabolism parameters on cardiac autonomic nervous function and their correlation were analyzed,and the optimal cutting point of cardiac autonomic nervous function was predicted by receiver operating characteristic(ROC)curve.Results SBP,heart rate(HR),FPG,PWV,PTH andβ-CTX in groups of 10 ng/ml,10~20 ng/ml and 20~30 ng/ml decreased in turn(P<0.05),while HDL-C,ABI,25(OH)D,Ca^(2+)and PNN50 decreased.Correlation analysis between Spearman and Pearson showed that 25(OH)D was positively correlated with SDNN,HRV triangle index,PNN50 and rMSSD(P<0.01).Logistic regression analysis showed that 25(OH)D,Ca^(2+)and HR were the influencing factors of cardiac autonomic nervous dysfunction in patients with T2DM.The ROC curve analysis showed that the areas under the ROC curve of 25(OH)D,Ca^(2+)and HR were 0.791,0.607 and 0.629,respectively,with sensitivity of 73.4%,53.2%and 38.7%,and specificity of 74.0%,93.6%and 81.4%,respectively.Conclusions 25(OH)D is the influencing factor of cardiac autonomic nervous dysfunction in patients with T2DM,and patients with high degree of deficiency are more prone to cardiac autonomic nervous dysfunction.