2型糖尿病患者静息心率预测早期糖尿病肾病的价值

摘要

目的 探讨2型糖尿病患者静息心率(RHR)预测早期糖尿病肾病的价值.方法 选择2013年1月～2016年12月就诊于扬州大学附属淮安市妇幼保健院内科门诊的120例2型糖尿病患者作为研究对象,按RHR水平将入选的患者分为三组:RHR1组(RHR≤70次/min)、RHR2组(70次/min＜RHR≤80次/min)和RHR3组(RHR≥80次/min).观察糖化血红蛋白、血肌酐、血尿素氮、估算肾小球滤过率和尿微量白蛋白等指标变化,通过绘制受试者工作曲线(ROC)预测早期肾损伤.结果 RHR3组尿微量白蛋白和估算肾小球滤过率均高于RHR1组和RHR2组,差异有统计学意义(P＜0.05).RHR与收缩压、舒张压、血肌酐和尿微量白蛋白均呈正相关(r＞0,P＜0.05);RHR与估算肾小球滤过率和立卧位心率差均呈负相关(r＜0,P＜0.05).RHR预测早期肾脏损伤ROC曲线下面积为0.881(0.806～0.956),差异有统计学意义(P＜0.05).其诊断界值为78次min,敏感度为76.7％,特异度为91.1％,阳性预测值为71.8％,阴性预测值为92.1％.结论 2型糖尿病患者的RHR与早期肾损伤相关,RHR可作为2型糖尿病发生早期糖尿病肾病的预警指标.%Objective To investigate the value of the resting heart rate (RHR) in predicting early diabetic nephropathy (EDN) in patients with type 2 diabetes mellitus.Methods One hundred and twenty patients with type 2 diabetes mellitus treated in department of internal medicine of Huai'an Maternity and Child Healthcare Hospital affiliated to Yangzhou university from January 2013 to December 2016 were selected as research objects.The enrolled patients were devided into RHR1 group (RHR≤70 times/min),RHR2 group (70 times/min＜RHR≤80 times/min) and RHR3 group (RHR ≥ 80 times/min) according to the RHR.The changes of glycosylated hemoglobin,serum creatinine,blood urea nitrogen,estimated glomerular filtration rate and urinary microalbumin were observed.The receiver operating characteristic (ROC) curve in predicting EDN by the RHR was drawn.Results The urinary microalbumin and estimated glomerular filtration rate in RHR3 group were higher than those in RHR1 group and RHR2 group respectively,and the differences were statistically significant (P ＜ 0.05).The RHR were respectively positively correlated with systolic blood pressure,diastolic blood pressure,serum creatinine and urinary microalbumin (r ＜ 0,P ＜ 0.05) and negatively correlated with the estimated glomerular filtration rate and the heart rate difference between standing position and supine position ((r ＞ 0,P ＜ 0.05).The area under the ROC curve of early renal injury predicted by RHR was 0.881 (0.806-0.956),the difference was statistically significant (P ＜ 0.05).The cutoff point of diagnosis was 78 times/min,sensitivity was 76.7％,specificity was 91.1％,positive predictive value was 71.8％ and negative predictive value was 92.1％.Conclusion In patients with type 2 diabetes mellitus,the RHR is correlated with early injury parameters of renal function,and the RHR might be used as a warning indexes of the early diabetic nephropathy.