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2型糖尿病患者的心脏自主功能障碍的密集血糖疗法:ACCORD试验
Yiquan Huang1, Peihan Xie1, Shaozhao Zhang1
1Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
Mayo Clinic proceedings
|September 10, 2023
概括
通过减少心血管事件,强化血糖治疗有利于2型糖尿病和低心率变化 (HRV) 的患者. 然而,在正常HRV患者中,它增加了全因死亡风险.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 糖尿病学 糖尿病学
背景情况:
- 心脏自主功能障碍,以低心率变化 (HRV) 表示,在2型糖尿病中很普遍.
- 密集型血糖治疗对心血管结果与HRV状态相关的影响还不清楚.
研究的目的:
- 调查低心率变化 (HRV) 是否会改变2型糖尿病患者密集血糖治疗的有效性和安全性.
- 分析HRV,密集的血糖控制和心血管事件,全因死亡率和低血糖之间的关联.
主要方法:
- 从ACCORD试验 (2001-2009) 中分析了7946名参与者.
- 心率变化 (HRV) 评估使用标准偏差的正常到正常间隔 (SDNN) 和连续差异的平方根平均值 (rMSSD).
- 异常HRV定义为SDNN和rMSSD的10百分位以下的值.
主要成果:
- 强化治疗在低HRV组显著减少了心血管事件 (SDNN:HR 0.57;rMSSD:HR 0.57).
- 在正常-HRV组中没有观察到心血管事件的显著减少 (SDNN:HR 0.90;rMSSD:HR 0.90).
- 强化治疗在正常HRV组增加了全因死亡风险 (SDNN:HR 1.21;rMSSD:HR 1.25) 但不是在低HRV组.
- 与低HRV组相比,在正常HRV组的强化治疗中发现了较高的低血糖风险.
结论:
- 低心率变化 (HRV) 识别了2型糖尿病患者,他们从密集的血糖治疗中获益更多.
- 心脏自主功能障碍 (低HRV) 与心血管事件风险降低有关,但在密集治疗中增加了全因死亡风险.
- 在正常HRV的2型糖尿病患者中,强化血糖治疗可能会带来比益处更大的风险 (全因死亡,低血糖症).
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