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首页> 外文期刊>Cardiovascular Diabetology >Assessment of heart rate variability (HRV) in subjects with type 2 diabetes mellitus with and without diabetic foot: correlations with endothelial dysfunction indices and markers of adipo-inflammatory dysfunction
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Assessment of heart rate variability (HRV) in subjects with type 2 diabetes mellitus with and without diabetic foot: correlations with endothelial dysfunction indices and markers of adipo-inflammatory dysfunction

机译：评估患有2型糖尿病患者的心率变异性（HRV），患有糖尿病患者，与糖尿病患者的相关性：与内皮功能障碍指标的相关性和脂肪炎症功能障碍的标记

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摘要

Some studies have suggested that patients with diabetes and foot complications have worse cardiovascular and cerebrovascular risk profiles, higher degrees of endothelial dysfunction and arterial stiffness and a higher inflammatory background than patients with diabetes without diabetic foot complications. Patients with diabetes mellitus have an alteration in the sympathovagal balance as assessed by means of heart rate variability (HRV) analysis, which is also related to the presence of endothelial dysfunction. Other studies suggest a possible role of inflammation coexisting with the alteration in the sympathovagal balance in favor of the atherosclerotic process in a mixed population of healthy subjects of middle and advanced age. The aim of this study was to evaluate the degree of alteration of sympathovagal balance, assessed by HRV analysis, in a cohort of patients with diabetes mellitus with diabetic foot and in control subjects without diabetic foot compared with a population of healthy subjects and the possible correlation of HRV parameters with inflammatory markers and endothelial dysfunction indices. We enrolled all patients with diabetic ulcerative lesions of the lower limb in the Internal Medicine with Stroke Care ward and of the diabetic foot outpatient clinic of P. Giaccone University Hospital of Palermo between September 2019 and July 2020. 4-h ECG Holter was performed. The following time domain HRV measures were analyzed: average heart rate, square root of the mean of successive differences of NN (RMSSD), standard deviation or square root of the variance (SD), and standard deviation of the means of the NN intervals calculated over a five-minute period (SDANN/5?min). The LF/HF ratio was calculated, reactive hyperemia was evaluated by endo-PAT, and serum levels of vaspine and omentin-1 were assessed by blood sample collection. 63 patients with diabetic foot, 30 patients with diabetes and without ulcerative complications and 30 patients without diabetes were enrolled. Patients with diabetic ulcers showed lower mean diastolic blood pressure values than healthy controls, lower MMSE scores corrected for age, lower serum levels of omentin-1, lower RHI values, higher body weight values and comparable body height values, HF% and LF/HF ratio values. We also reported a negative correlation between the RHI value and HRV indices and the expression of increased parasympathetic activity (RMSDD and HF%) in subjects with diabetic foot and a statistically significant positive correlation with the LF/HF ratio and the expression of the sympathovagal balance. Patients with diabetic foot show a higher degree of activation of the parasympathetic system, expressed by the increase in HF values, and a lower LF/HF ratio. Our findings may corroborate the issue that a parasympathetic dysfunction may have a possible additive role in the pathogenesis of other vascular complications in subjects with diabetic foot.
机译：一些研究表明，糖尿病和足部并发症的患者具有较差的心血管和脑血管障碍，高度程度的内皮功能障碍和动脉僵硬度以及比没有糖尿病足迹的糖尿病患者更高的炎症背景。糖尿病患者具有通过心率变异性（HRV）分析评估的同性化平衡的改变，这也与内皮功能障碍的存在有关。其他研究表明，炎症共存的可能作用与伴有同性恋症的变化的变化有利于中高龄和晚期健康受试者的混合群体的动脉粥样硬化过程。本研究的目的是评估Sympathoval平衡的改变程度，通过HRV分析评估，在糖尿病患者的糖尿病患者患者中，与糖尿病患者的糖尿病患者和没有糖尿病患者的对照组，与健康受试者的群体和可能的相关性具有炎症标记的HRV参数和内皮功能障碍指标。我们在2019年9月至7月20日期间，我们注册了内部医学中的糖尿病溃疡病变的糖尿病溃疡病变和P.Giaconcone大学巴勒莫大学P.Giaconcone大学医院的糖尿病脚门诊。分析了以下时间域HRV措施：平均心率，平均NN（RMSSD）的平均差异，标准偏差或方差的平方根（SD），以及计算的NN间隔的平均值的标准偏差在5分钟（SDANN / 5？分钟）。计算LF / HF比率，通过Endo-PAT评估反应性高血量，并通过血液样品收集评估血清血清水平和胃膜1。 63例糖尿病患者，30例糖尿病患者和没有溃疡性并发症的患者和30名没有糖尿病患者。糖尿病溃疡的患者表现出低于健康对照的平均舒张压值，较低的MMSE评分校正，较低的年龄，血清血清水平，较低的RHI值，更高的体重值和相当的体高值，HF％和LF / HF比率值。我们还报告了RHI值和HRV指数与糖尿病患者受试者中增加的副交感度活性（RMSDD和HF％）的负相关性以及与LF / HF比率的统计学上显着的阳性相关性以及对同性化平衡的表达。患有糖尿病脚的患者显示出副交感神经系统的较高程度，由HF值的增加表达，LF / HF比率较低。我们的研究结果可以证实副交感神经功能障碍在糖尿病足科目的其他血管并发症的发病机制中可能具有可能的添加剂作用。

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