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目的 T波电交替(TWA)是心肌梗死后、缺血性心肌病、心力衰竭等患者发生心脏性猝死(SCD)的独立预测因子。相关研究报道糖尿病患者发生SCD的风险增加,但缺乏数据表明糖尿病患者微伏级T波电交替(microvoltT-Wave Alternans,MTWA)异常比例增加,本试验主要探讨糖尿病是否使MTWA异常的比例增高。方法选择自2000年1月至2011年5月兰州大学第一医院内科198例行平板运动试验的患者,分为A组:对照组,B组:糖尿病组,C组:冠心病组,D组:糖尿病合并冠心病组。用Logistic回归法对纳入患者MTWA与疾病相关性进行分析,并进一步分析糖尿病患者MTWA异常比例增高与血糖控制水平及病史的相关性。结果 Logistic回归显示异常MTWA与冠心病相关(p<0.001,OR=4.91,95%CI:2.52-9.55),与糖尿病相关(p=0.008,OR=2.39,95%CI:1.26-4.53)。对糖尿病患者进行Logistic回归显示MTWA异常仅与糖化血红蛋白相关(p=0.02,OR=6.00,95%CI:1.37-26.24),与糖尿病病史长短无关。结论 2型糖尿病患者中异常MTWA常见,异常比例为23.40%,MTWA异常比例增加与血糖控制水平具有相关性。
Objective T wave alternation (TWA) is an independent predictor of sudden cardiac death (SCD) in patients with myocardial infarction, ischemic cardiomyopathy, and heart failure. However, a paucity of data suggest that the proportion of microvolt T-Wave Alternans (MTWA) in diabetic patients increases. This study investigated whether diabetes increased the proportion of abnormal MTWA. Methods From January 2000 to May 2011, 198 cases of treadmill exercise test in the First Hospital of Lanzhou University were divided into group A: control group, group B: diabetes group, group C: coronary heart disease group, group D : Diabetes with coronary heart disease group. Logistic regression analysis was used to analyze the association between MTWA and disease in patients and to further analyze the correlation between the abnormal increase of MTWA and the level of glycemic control and history in diabetic patients. Results Logistic regression showed that abnormal MTWA was associated with coronary heart disease (p <0.001, OR = 4.91, 95% CI: 2.52-9.55) and was associated with diabetes (p = 0.008, OR = 2.39, 95% CI: 1.26-4.53). Logistic regression analysis of patients with diabetes showed that MTWA abnormalities were only associated with glycosylated hemoglobin (p = 0.02, OR = 6.00, 95% CI: 1.37-26.24), independent of the duration of diabetes. Conclusions The abnormal MTWA in type 2 diabetic patients is common and the abnormal proportion is 23.40%. The increase of MTWA abnormalities is correlated with the level of blood sugar control.