Bozulmuş açlık glukozu, bozulmuş glukoz toleransı ve tip 2 diyabetes mellitus tanısı olan kişilerde kalp hızı değişkenliği ve kalp hızı toparlanma zamanının glukometabolik anormalliği bulunmayan kişilerle karşılaştırılması
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Tarih
2011
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda glukometabolik anormalliği olan ve normal glukoz homeostazına sahip olan hastalar arasındaki kardiyak otonom fonksiyon göstergelerini egzersiz stres testi ve Holter elektrokardiyografi verilerini kullanarak karşılaştırmayı amaçladık. Çalışmaya toplam 90 hasta dahil edildi, bunların 21'i diyabetes mellitus, 18'i bozulmuş açlık glukozu, 25'i bozulmuş glukoz toleransı ve 26'sı glukometabolik anormalliği bulunmayan hastalardı. Ortalama yaş sırasıyla diyabetes mellitus, bozulmuş açlık glukozu, bozulmuş glukoz toleransı ve kontrol grubunda 51.5±8.0, 51.3±10.5, 49.0±8.0 ve 46.7±9.3 olarak saptandı. Dört grup arasında egzersiz stres testi verilerinden metabolik eşdeğerlilik diyabetik grupta daha düşük tespit edildi; fakat istatistiki anlamlılığa ulaşılamadı. Diyabetik grupta bazal kalp hızı diğer gruplara göre daha yüksek olmasına rağmen burada da istatistiki anlamlılığa ulaşılamadı. Holter elektrokardiyografi verilerinde ise anlamlı farklılık saptanmadı. Klinik ve laboratuar verilerinden bel çevresi, trigliserid ve insülin düzeyleri, açlık kan şekeri, insülin direnci ve hemoglobin A1c değerleri normal glukoz homeostazisine sahip gruba göre prediyabetik ve diyabetik grupta anlamlı olarak daha yüksek saptandı. Tüm gruplarda açlık kan şekeri ile otonom fonksiyon göstergelerinin korelasyon analizinde açlık kan şekerinin bazal kalp hızı ve düşük frekans/yüksek frekans oranı ile pozitif korele, normal RR sürelerinin aralarındaki farkların karelerinin ortalamasının karekökü ve yüksek frekans ile negatif korele olduğunu saptadık. Ayrıca hemoglobin A1c seviyesi ile kalp hızı toparlanma zamanı, kalp hızı indeksi, normal RR sürelerinin aralarındaki farkların karelerinin ortalamasının karekökü ve yüksek frekans değeri ile negatif korele olduğunu tespit ettik. Açlık kan şekerinin bağımlı değişken olduğu çok değişkenli regresyon analizinde bazal kalp hızı yüksekliğinin artmış sempatik aktiviteyle ilişkili olarak artmış açlık kan şekeri ile ilişkili olduğunu saptadık. Sonuç olarak normal gruba göre metabolik eşdeğerliliğin prediyabetik ve diyabetik grupta azalmış olması ve maksimum metabolik eşdeğerlilik düzeyi azalmasının artmış mortalite ile ilişkili olması gösterilmiş olduğundan glukometabolik anormallik saptanan tüm hastaların başlangıçta egzersiz stres testi ile değerlendirilmesinin uygun olacağı kanısındayız.
Abstract
In our study we aimed to compare cardiac autonomic function parameters among patients who have gluco-metabolic abnormality and those without gluco-metabolic abnormality by using exercise stress test and Holter electrocardiography data. We included 90 subjects to our study, 21 patients had type 2 diabetes mellitus, 18 had impaired fasting glucose, 25 had impaired glucose tolerance and 26 subjects were randomised as the control group with normal gluco-metabolic hemostasis. The mean age of diabetes mellitus, impaired fasting glucose, impaired glucose tolerance and control group was 51.5±8.0, 51.3±10.5, 49.0±8.0 and 46.7±9.3, respectively. Among these 4 groups metabolic equivalent level, which is a parameter of exercise stress test, was decreased in the diabetic group; but not statistically significant. Resting heart rate level was increased in the diabetic group; but also not statistically significant. There were no significant difference between the Holter electrocardiography parameters. The waist circumference, triglyceride, fasting plasma glucose, insulin, insulin resistance and hemoglobin A1c levels were significantly higher in pre-diabetic and diabetic group compared to normal group. In all groups, there was negative correlation between fasting plasma glucose and the root mean square successive difference, high frequency; however there was positive correlation between resting heart rate levels and low frequency/high frequency ratio. We also observed negative correlation between hemoglobin A1c and heart rate recovery, heart rate index, the root mean square successive difference and high frequency levels which were associated with cardiac autonomic balance. Fasting blood glucose which was the dependent variable in multivariate regression analysis, we found that basal heart rate in relation to the height of the increased sympathetic activity is associated with elevated fasting blood glucose. As a result, according to the decreased metabolic equivalent level in pre-diabetic and diabetic groups and the maximum reduction in the level of metabolic equivalent is shown to be associated with increased mortality; we suggest that patients who have glucometabolic abnormality should be evaluated also with exercise stress testing initially.
Abstract
In our study we aimed to compare cardiac autonomic function parameters among patients who have gluco-metabolic abnormality and those without gluco-metabolic abnormality by using exercise stress test and Holter electrocardiography data. We included 90 subjects to our study, 21 patients had type 2 diabetes mellitus, 18 had impaired fasting glucose, 25 had impaired glucose tolerance and 26 subjects were randomised as the control group with normal gluco-metabolic hemostasis. The mean age of diabetes mellitus, impaired fasting glucose, impaired glucose tolerance and control group was 51.5±8.0, 51.3±10.5, 49.0±8.0 and 46.7±9.3, respectively. Among these 4 groups metabolic equivalent level, which is a parameter of exercise stress test, was decreased in the diabetic group; but not statistically significant. Resting heart rate level was increased in the diabetic group; but also not statistically significant. There were no significant difference between the Holter electrocardiography parameters. The waist circumference, triglyceride, fasting plasma glucose, insulin, insulin resistance and hemoglobin A1c levels were significantly higher in pre-diabetic and diabetic group compared to normal group. In all groups, there was negative correlation between fasting plasma glucose and the root mean square successive difference, high frequency; however there was positive correlation between resting heart rate levels and low frequency/high frequency ratio. We also observed negative correlation between hemoglobin A1c and heart rate recovery, heart rate index, the root mean square successive difference and high frequency levels which were associated with cardiac autonomic balance. Fasting blood glucose which was the dependent variable in multivariate regression analysis, we found that basal heart rate in relation to the height of the increased sympathetic activity is associated with elevated fasting blood glucose. As a result, according to the decreased metabolic equivalent level in pre-diabetic and diabetic groups and the maximum reduction in the level of metabolic equivalent is shown to be associated with increased mortality; we suggest that patients who have glucometabolic abnormality should be evaluated also with exercise stress testing initially.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Egzersiz Stres Testi, Glukometabolik Anormallik, Holter Elektrokardiyografi, Otonom Disfonksiyon, Autonomic Dysfunction, Exercise Stress Test, Glucometabolic Abnormality, Holter Electrocardiography
