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Ezscan在评估糖尿病心脏自主神经功能中的价值 第2页

更新时间:2012-4-27:  来源:毕业论文
Holter记录:Holter记录仪(SpiderView, Ela medical),在仪器内输入患者性别和编号,将电极通过电极片贴于患者胸前,开始记录。4小时候后关闭机器,拆下电极,4小时内嘱患者如常活动。分析方法包括频谱分析发和时域分析法,频谱分析法中频谱总范围是0-0.40 Hz,又分为高频(HF: 0.15-0.40 Hz)、低频(LF: 0.04-0.15 Hz)和极低频(VLF: <0.40 Hz),LF/HF标准化了高频和低频。时域分析法的指标有24h 窦性 R - R间期均值标准差(SDNN),24h R - R 连续差异均方的平方根(rMSSD),这些分析工作是由SyneSCOPE软件进行。
    经典实验[21]:由五项指标综合评定:①Valsalva动作反应指数②深呼吸心率差③卧立位心律变化④卧立位血压差⑤持续握力血压变化。
统计分析:结果的计量资料用均数±标准差来表示,当p< 0.05是统计学上有显著差异,统计分析是用R 2.9.2统计软件完成的[19]。
研究结果:
表1显示144例入组者基本情况和实验室检查,包括HRV参数及EZSCAN的结果。表2反映HRV和EZSCAN95%可信区间的相关系数。结果发现LF的和EZSCAN的结果的显著相关,相关系数是r=0.39(p< 0.01)。而LF/HF与EZSCAN的相关性略低(r=0.28, p = 0.0005).EZSCAN结果和其他HRV的指标相关性较差,同时LF和HbA1c无相关性(r=0.07, p = 0.44)。以经典实验为标准,Ezscan的敏感度为58.3%,特异度为57.8%。白蛋白/肌酐>30mg/mmol的患者,他们手部和足部的ESC要低于白蛋白/肌酐<30mg/mmol的患者(61±19 vs 53±35 µSi, p = 0.003 and 56±28 vs 43±48 µSi, p= 0.018,图3)。患者收缩压与Ezscan的相关系数是r=0.357(p< 0.01),舒张压与Ezscan无明显相关性(p> 0.05)。研究过程中及研究结束后无安全不良事件发生。
讨论:TMS320VC5501 DSP吉他效果器设计+电路原理图+PCB图+源程序
本研究通过检测尚未发现糖尿病并发症的糖尿病患者并发症情况,发现在评估自主神经功能方面,EZSCAN的结果和Holter显示的LF的结果有着显著的相关性。
EZSCAN通过反向离子分析法及计时电流分析法来测定汗液中氯离子浓度从而评估汗腺功能[16,17]。有证据表明汗腺功能障碍是由于糖尿病早期神经小纤文受损所致[5]。QSART是一种评估交感节后促汗传出神经完整性的方法,他主要是检测糖尿病患者有无典型的自主神经病变症状如早期体位性低血压[7,22]。早期体位性低血压的出现与自主神经病变的发展过程相一致。
LF与β细胞凋亡之间有明显的联系,这种联系与EZSCAN和LF之间的联系是相一致的。
本研究的结果和在法国的研究结果相一致。在法国的预试验中,35名确诊糖尿病但无并发症的患者,他们休息时和运动时的LF和EZSCAN的测量值有着明显的联系。与此同时,在印度有一项涉及144人的糖尿病研究,他们不仅使用EZSCAN进行评估还加用了Ewing’s的一项症状评分实验,EZSCAN的结果和评分实验也有较好的相关性。(印度实验的文章尚未发表)
关于EZSCAN对白蛋白尿的评估价值,我们的结果和香港(Pr J Chan, article submitted to Diabetes Therapeutics and Technology)的Ezscan研究相一致。虽然在非DKD的人群中,EZSCAN貌似有着更好的评估价值,但这也真实地反映了机器的敏感度,提示EZSCAN评估DKD风险较高的患者在今后肾功能恶化的风险似乎更高。
在各种评估汗腺功能的试验中安全无创伤[20]。
本研究认为EZSCAN是一种可行的筛查心脏自主神经功能的方法,它既省时又方便。早期筛查CAN和白蛋白尿有益于糖尿病并发症的防治。

参考文献:
1 Ramachandran A., Wan Ma RC, Snehalatha C. Diabetes in Asia. Lancet 2010; 375:408-418.

2 Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB: Diabetes in Asia: epidemiology, risk factors, and pathophysiology. Jama 2009;301:2129-2140.

3 Williams R, Van Gaal L, Lucioni C. Assessing the impact of complications on the costs of Type II diabetes. Diabetologia 2002;45:S13-S17.

4 Vinik A.R, Maser R.E., Mitchell B.D., Freeman R. Diabetic Autonomic Neuropathy Diabetes Care 2003;26:1553-1579

5 Tesfaye S., Chaturvedi N., Eaton S.E.,et al. Vascular Risk Factors and Diabetic Neuropathy. N Engl J Med 2005;352:341-50.

6 Ducher M, Cerutti C, Gustin MP et al. Noninvasive exploration of cardiac autonomic neuropa thy. Four reliable methods for diabetes? Diabetes Care 1999;22:388–393

7 Low PA. Pitfalls in autonomic testing. In Low PA, ed. Clinical autonomic disorders: evaluation and management. Boston: Little, Brown, 1993:335-365.

8 Wu AY, Kong NC, de Leon FA, Pan CY, Tai TY, Yeung VT, Yoo SJ, Rouillon A, Weir MR: An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 2005; 48:1674-1675.

9 Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S: Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. Jama 2001;286:421-426,

10 So WY, Kong AP, Ma RC, Ozaki R, Szeto CC, Chan NN, Ng V, Ho CS, Lam CW, Chow CC, Cockram CS, Chan JC, Tong PC: Glomerular filtration rate, cardiorenal end points, and all-cause mortality in type 2 diabetic patients. Diabetes Care 2006;29:2046-2052

11 Clarke PM, Glasziou P, Patel A, Chalmers J, Woodward M, Harrap SB, Salomon JA: Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis. PLoS Med 7:e1000236

12 Parving HH, Lewis JB, Ravid M, Remuzzi G, Hunsicker LG: Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 2006;69:2057-2063.

13 Wu AY, Kong NC, de Leon FA, Pan CY, Tai TY, Yeung VT, Yoo SJ, Rouillon A, Weir MR: An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 2005;48:1674-1675.

14 Chan JC, Gagliardino JJ, Baik SH, Chantelot JM, Ferreira SR, Hancu N, Ilkova H, Ramachandran A, Aschner P: Multi-faceted Determinants For Achieving Glycemic Control: The International Diabetes Management Practice Study (IDMPS). Diabetes Care 2008; 32:227-233

15. Araki S, Haneda M, Sugimoto T, Isono M, Isshiki K, Kashiwagi A, Koya D: Factors Associated With Frequent Remission of Microalbuminuria in Patients With Type 2 Diabetes. Diabetes 2005;54:2983-2987

16 H. Mayaudon, P. O. Miloche, B.  Bauduceau. A new simple method to assess sudomotor function: interest in type diabetes. Diabetes and metabolism (in press).

17 D. Hubert, P. Brunswick, D. Dusser, I. Fajac. Abnormal electrochemical skin conductance in cystic fibrosis. Journal of Cystic Fibrosis (in press).

18 Chizmadzhev A, Indenbom A.V., Kuzmin P. L. et al., “Electrical Properties of Skin at Moderate Voltages: Contribution of Appendageal Macropores,” Biophysical Journal 1998; vol. 74, pp. 843–856, 1998.

19 Myles Hollander \& Douglas A. Wolfe (1999). Nonparametric Statistical Methods, 2nd Edition, page 244. New York: John Wiley & Sons.

20. Report and recommendations of the San Antonio Conference on Diabetic Neuropathy. Consensus statement. Diabetes 1988;37:1000-1004 从优秀到卓越读后感

21. Ewing DJ, Martyn CN, Young RJ, Clarke BF: The value of cardiovascular autonomic function tests: 10 years’ experience in diabetes. Diabetes Care,1985, 8:491–498,

22.Hiroshi ITOH ,Seiji UEBORI, Mahito ASAI, Tagui KASHIWAYA, Keita ATOH, Isao MAKINO: Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test(QSART) in Type 2 Diabetic Patients. Internal Medicine, 2003;42:560-564

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