本文選題：2型糖尿病 + 心臟自主神經(jīng)病變　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.探討糖尿病性心臟自主神經(jīng)病變(DCAN)和心率變異性(HRV)的特點(diǎn)。2.探討血清IL-1、IL-6、TNF-α水平對DCAN發(fā)病風(fēng)險(xiǎn)的影響。3.探討DCAN的影響因素,為探討DCAN的發(fā)病機(jī)制提供一定基礎(chǔ)。方法:1.收集資料:試驗(yàn)組(DM組)選取2013年9月-2014年4月于天津醫(yī)科大學(xué)代謝病醫(yī)院神經(jīng)內(nèi)科住院治療的T2DM患者124例,對照組(NC組)選取健康查體者49例。收集所有受試者的一般臨床資料、空腹靜脈血檢測生化指標(biāo)、酶聯(lián)免疫法測量血清人白細(xì)胞介素1(IL-1)、人白細(xì)胞介素6(IL-6)、人腫瘤壞死因子α(TNF-α),并根據(jù)公式HOMA-IR=FPG×FINS/22.5計(jì)算胰島素抵抗指數(shù)。2.所有接受試驗(yàn)者給予24小時(shí)全導(dǎo)動態(tài)心電圖分析檢測,取得HRV指標(biāo)。根據(jù)所得HRV指標(biāo),其中DM組HRV異常受試者69例,為DCAN組,正常者55例,為NDCAN組。3.應(yīng)用單因素方差分析、卡方檢驗(yàn)比較DM組與NC組之間以及NC組、DCAN組與NDCAN組之間的一般資料,IL-1、IL-6、TNF-α、HRV各項(xiàng)指標(biāo),以及進(jìn)行IL-1、IL-6、TNF-α與HRV各項(xiàng)指標(biāo)相關(guān)分析,多因素二元Logistic回歸分析DCAN影響因素。結(jié)果:1.IL-1與年齡、病程、SBP、BMI、WHR、HbA1c、FPG、UMA水平正相關(guān),與SDNN、SDANN、LF、HF、LF(NORM)呈負(fù)相關(guān);IL-6和TNF-α均與年齡、病程、BMI、WHR、Hb A1c、FPG、Cr、UMA水平正相關(guān),與e GFR、SDNN、SDANN、LF、HF、LF(NORM)、LF/HF均呈負(fù)相關(guān)(P0.05);2.DCAN組在年齡、BMI、WHR、FPG、Hb A1c、UMA、LDL、e GFR方面高于NC組,NDCAN組在年齡、BMI、WHR、FPG、Hb A1c、UMA、e GFR方面高于NC組,DCAN組在UMA、糖尿病病程、DR、DKD患病率方面高于NDCAN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);3.DCAN組在IL-1、IL-6、TNF-α濃度方面高于NC和NDCAN組,NDCAN組在IL-6、TNF-α濃度方面高于NC組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4.DCAN組在SDNN、SDANN、LF、HF、LF(norm)、LF/HF方面低于NC組,NDCAN組在SDNN、SDANN、RMSSD、LF、HF、LF(norm)、HF(norm)、LF/HF方面低于NC組,DCAN組在SDNN、SDANN、RMSSD、LF、HF、LF(norm)、HF(norm)方面低于NDCAN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);5.經(jīng)多因素多元logistic回歸顯示病程、UMA、IL-1、IL-6、TNF-α為DCAN的危險(xiǎn)因素,SDNN為DCAN的保護(hù)因素;6.UMA的三分位數(shù)將所有數(shù)據(jù)分為3組,由低到高依次為UMA1、UMA2、UMA3,發(fā)現(xiàn)三組間血清IL-1、IL-6、TNF-α濃度呈上升趨勢,SDNN、SDANN、RMSSD、LF、HF、LF(norm)、LF/HF呈降低趨勢,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。7.分別將IL-1、IL-6、TNF-α以四分位數(shù)分組,由低到高順序分為1-4組,血清IL-1、IL-6、TNF-α水平隨受試者年齡、DM病程、Hb A1c、FPG的逐漸增加而升高,而SDNN、SDANN、LF、HF、LF(norm)呈降低趨勢,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.炎癥因子IL-1、IL-6、TNF-α與DCAN的發(fā)病密切相關(guān)。2.DCAN組的HRV指標(biāo)普遍呈下降趨勢,而HF(norm)可能更早于其他指標(biāo)出現(xiàn)下降。3.病程、UMA、IL-1、IL-6、TNF-α為DCAN的危險(xiǎn)因素,SDNN為DCAN的保護(hù)因素。4.DCAN與T2DM微血管并發(fā)癥存在著相關(guān)性,且炎癥因子IL-1、IL-6、TNF-α與DKD的發(fā)病密切相關(guān)。
[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- 偽 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 偽 (TNF- 偽) 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- 偽 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- 偽 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紓鏈夌粺璁″鎰忎箟(P0.05);3.DCAN緇勫湪IL-1,IL-6,TNF-偽嫻撳害鏂歸潰楂樹簬NC鍜孨DCAN緇，

本文編號：1883049