Diabetes Care：糖尿病与心衰患者心脏交感神经活性降低相关

糖尿病和非糖尿病心衰患者HbA1c与早期和延迟期H/M比值的相关性

糖尿病(DM)患者存在副交感和交感神经系统活性受损，并且与不良的预后相联系。然而，DM对心衰(HF)患者心脏神经病变的影响尚缺乏研究数据。为了评价DM和非DM心衰患者的心脏交感神经活性，来自意大利费德里克二世大学心血管病科高级医学科学系的Paolillo博士等人进行了一项研究，研究发现DM心衰患者心脏交感神经活性比单纯的HF患者或DM患者低。研究结果在线发表于2013年3月25日的美国《糖尿病护理》(Diabetes Care)杂志上。
研究人员对75例严重HF患者 (其中糖尿病患者37例，非糖尿病患者38例)和14例心脏功能正常的糖尿病患者行123I-间碘苄胍心肌显像，根据图像计算早期和延迟期心脏与纵隔 (H/M) 比值。测定临床、超声心动图和生化数据。
结果显示，与无DM患者比较，DM患者早期H/M比值(1.65±0.21 vs.1.75±0.21;P<0.05)和延迟期H/M比值(1.46±0.22 vs. 1.58±0.24;P<0.03)显著降低。无HF的DM患者早期和延迟期H/M比值(分别为2.22±0.35和1.99±0.24)较有和无DM的HF患者显著升高(P<0.0001)。在HF患者中，早期和延迟期H/M比值与糖化血红蛋白A1c(HbA1c)呈负相关(Pearson相关系数=-0.473，P=0.001；Pearson =-0.382，P=0.001)。多变量分析结果显示，在DM患者中，HbA1c与射血分数仍然是早期H/M的重要预测因子；HbA1c仍然是唯一的延迟期H/M的重要预测因子。在非糖尿病患者中，未发现早期或延迟期H/M与HbA1c间有相关性。
研究表明，糖尿病HF患者的心脏交感神经活性比单纯的HF患者或自主功能障碍程度相似的单纯糖尿病患者低。HbA1c与心脏交感神经活性降低程度相关。
与糖尿病相关的拓展阅读：

• Diabetes Care：lixisenatide有效改善二甲双胍控制不佳的2型糖尿病人群的血糖
• 2013 NIH 妊娠期糖尿病(GDM)诊断声明
• JAMA：褪黑激素分泌减少增加II型糖尿病风险
• DIABETES CARE：空腹血糖筛查妊娠糖尿病添新证
• Eur J Endocrinol: 1型糖尿病患者HbA1c水平过高能直接导致抑郁
• Diabetes Care：HbA1c水平的波动与糖尿病肾病有关 更多信息请点击：有关糖尿病更多资讯

Impact of Diabetes Mellitus on Cardiac Sympathetic Innervation in Patients With Heart Failure
A 123I meta-iodobenzylguanidine (123IMIBG) scintigraphic study
OBJECTIVE
Impaired parasympathetic and sympathetic nervous system activity have been demonstrated in patients with diabetes mellitus (DM) and correlated with worse prognosis. Few data are available on the effect of DM on cardiac neuropathy in heart failure (HF). The aim of the current study was to assess cardiac sympathetic activity in HF patients with and without DM.
RESEARCH DESIGN AND METHODS
Patients with severe HF (n = 75), with (n = 37) and without DM (n = 38), and 14 diabetic patients with normal cardiac function underwent 123I meta-iodobenzylguanidine scintigraphy from which early and late heart-to-mediastinum (H/M) ratios were calculated. Clinical, echocardiographic, and biochemical data were measured.
RESULTS
DM compared with non-DM patients showed significantly lower early (1.65 ± 0.21 vs. 1.75 ± 0.21; P < 0.05) and late H/M ratios (1.46 ± 0.22 vs. 1.58 ± 0.24; P < 0.03). Early and late H/M were significantly higher in DM patients without HF (2.22 ± 0.35 and 1.99 ± 0.24, respectively) than HF patients with (P < 0.0001) and without (P < 0.0001) DM. In HF patients, an inverse correlation between early or late H/M ratio and hemoglobin A1c (HbA1c) (Pearson = −0.473, P = 0.001; Pearson = −0.382, P = 0.001, respectively) was observed. In DM, in multivariate analysis, HbA1c and ejection fraction remained significant predictors of early H/M; HbA1c remained the only significant predictor of late H/M. No correlation between early or late H/M and HbA1c was found in non-DM patients.
CONCLUSIONS
Diabetic patients with HF show lower cardiac sympathetic activity than HF patients not having DM or than DM patients with a similar degree of autonomic dysfunction not having HF. HbA1c correlated with the degree of reduction in cardiac sympathetic activity.