當心跳變異性(heart rate variability)或壓力反射敏感度(baroreflex sensitivity)減少時，即使沒有自主神經病變的臨床症狀，其死亡的危險性仍會升高。本篇研究在於探討心跳變異性與葡萄糖耐受不良(glucose intolerance)之相關性，並且在正常血糖、葡萄糖耐受異常(impaired glucose tolerance)與糖尿病三組受檢者中作自發性壓力反射分析與Valsalva測驗對於壓力反射敏感度之比較。
　　我們選取83位糖尿病病人、經年齡配對之83位葡萄糖耐受異常及166位正常血糖之受檢者，每位受檢者皆接受以Colin BP-508 Automatic BP monitor system作5分鐘之心跳及血壓測量的紀錄，並作2次的Valsalva測驗。心跳變異性的時域分析包括RR時間間距的標準差(SDNN)及相鄰RR時間間距之差的均方根值(RMSSD)，頻域分析則以快速Fourier轉換作頻譜分析，低頻為0.04 – 0.15 Hz、高頻為0.15 – 0.40Hz；另外也作收縮壓的頻域分析。在壓力反射分析上，Valsalva比值小於1.2視為異常；自發性壓力反射之 spectral a coefficient為RR時間間距與收縮壓在低頻之power比值的平方根。
　　結果顯示與正常血糖組比較，葡萄糖耐受異常與糖尿病這兩組的時域分析(包括SDNN與RMSSD)及頻域分析(高、低頻的power)均有明顯的減少；但在低、高頻power的比值及收縮壓的頻域分析於正常血糖、葡萄糖耐受異常與糖尿病三組間則無明顯統計學上之差異。在壓力反射分析方面，Valsalva比值異常(小於1.2)之比率在正常血糖、葡萄糖耐受異常與糖尿病三組分別為1.8、6.0、及12.3% (p=0.001)；經調整其他因子後，Valsalva比值異常與糖尿病仍有獨立的相關性，但與葡萄糖耐受異常則無明顯獨立的相關性。在自發性壓力反射方面，葡萄糖耐受異常與糖尿病組比正常血糖組有較低的的spectral a coefficient，經調整其他因子後，spectral a coefficient減少的現象仍然存在。因此本篇的結論為葡萄糖耐受異常與糖尿病者之心跳變異性比血糖正常者有減少的現象，但血壓變異性則與血糖正常者無明顯差別。就壓力反射敏感度與葡萄糖耐受不良的相關性而言，spectral a coefficient與葡萄糖耐受不良的相關性比Valsalva ratio為佳。

　　Reduced heart rate variability (HRV) and baroreflex sensitivity (BRS), even in subclinical state, increases the risk of mortality. The aims of this study are to clarify the relationship between HRV and glucose intolerance and also to compare the spontaneous BRS analysis and Valsalva test for assessment of baroreflex function in subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM).
　　Eighty-three DM patients, 83 age-matched IGT and 166 NGT subjects were recruited. Recordings of the heart rate and blood pressure signals with Colin BP-508 Automatic BP monitor system were collected for 5 minutes and Valsalva test was performed twice after then. Standard deviation of RR interval (SDNN), root mean square of successive differences (RMSSD), and low (LF: 0.04–0.15 Hz) and high frequency (HF: 0.15–0.4 Hz) components derived from spectral analysis with fast Fourier transformation were calculated. Impaired Valsalva ratio was defined as <1.2. Spontaneous BRS were determined by spectral a coefficient method, i.e. square root of the ratio between the power of RR interval and the power of systolic blood pressure (SBP) in the LF region.
　　SDNN, RMSSD, HF and LF power spectra of RR interval were reduced in both DM and IGT subjects, as compared with NGT subjects. However, LF power/ HF power, SBP variability, and Valsalva ratio were not significantly different among subjects with NGT, IGT, and DM in multiple regression analysis. When compared to NGT subjects, both the DM and IGT subjects had a lower spectral a coefficient. The diabetic patients, not the IGT subjects, suffered a higher prevalence of impaired Valsalva ratio than NGT subjects. In conclusion, impaired HRV in time & frequency domain, but not the SBP variability, are found in both DM and IGT subjects. Spontaneous baroreflex analysis with spectral a coefficient is more correlated to subjects with glucose intolerance as compared with Valsalva ratio.

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