| Objective: The pathobiology foundation of diabetes mellitus(DM) cardiovascular autonomic neuropathy(CAN) is micrangium affection, the endothelium dysfunction and injury has a close relationship with DM complications. There is a intimate relationship between Hepatocyte growth factor(HGF), interleukin-6(IL-6) and endothelium function,which has been certified by most studies . The aim of this study is to investigate the association between HGF,IL-6 and CAN in type 2 diabetes mellitus(T2DM),and the correlation between HGF,IL-6 and various kinds of factors of CAN in T2DM. It also analyzes the association between squatting test and heart rate variability(HRV),providing clinical diagnosis evidence of CAN accordingly.Methods: 60 in-ward patients with T2DM hospitalized in the Second Hospital of Hebei Medicine University from October, 2007 to November, 2008.All patients must be examined squatting test and dynamic electrocardiogram in 24 hours,then according to the value of squatting test SqTv,SqTs divide three groups. There are 20 patients (A group) without the abnormality of the result of squatting test, 11 males and 9 females, average aged 55.00±9.56 years old; there are 21 patients (B group) with one of squatting test results abnormal, 10 males and 11 females, average aged 57.69±12.63 years old; there are 19 patients (C group) with both of squatting test results abnormal, 9 males and 10 females, average aged 56.12±12.60 years old. Normal control (N group) 30 men, 16 males and 14 females, average aged 55.57±10.12 years old. All of normal control people also examine squatting test and dynamic electrocardiogram in 24 hours. The diagnosis of T2DM accorded with the new diagnosis criteria of WHO in 1999. The determination of blood serum HGF,IL-6 is based on ELISA. Compared the differences of the common conditions, HRV index, squatting test result, HGF,IL-6 and so on in four groups and study the association between HGF,IL-6 and CAN in type 2 diabetes mellitus.Result:1 The comparison of common conditionsCompared with N group, TC,TG,LDL and FIB level was higher in T2DM groups(p<0.05),HDL level was lower in T2DM groups(p<0.05).There was statistics significance of HbA1c and HDL between A,C groups, but there were no differences in TC,TG,LDL,FIB among three T2DM groups (p>0.05). There were significant differences in course of DM among A, B, C groups(p<0.01).2 The comparison of the level of blood serum HGF,IL-6Compared with N group, the level of blood serum HGF,IL-6 was much higher in M group (to merge A,B,C groups as M group, p<0.01). There were significant differences of the level of blood serum IL-6 among A, B, C, N groups(p<0.01). Except no statistics significance of the level of blood serum HGF between A,B groups(P=0.07), there were significant differences among other groups(p<0.01).3 The comparison of index of HRVCompared with N group, index of HRV were lower in M group (p<0.01). There were significant differences in SDNNindex, rMSSD, TP, VLF, HF and the minimum value of frequency of HRV among A, B, C ,N groups(p<0.01). Except no statistics significance of SDNN, SDANNindex between A,N groups(p>0.05), there were statistics differences among other groups(p<0.05). There were no statistics differences in LF, PNN50 betweenA,B groups(p>0.05). There were no statistics differences in the maximum value of frequency of HRV among A, B, C groups(p>0.05). There were no statistics differences in the value of LF/HF among A, B, C,N groups(p>0.05).4 The comparison of the result of squatting testThere were significant differences in the value of SqTv and SqTs between N group and M group (p<0.01),and the differences also existed among A, B, C,N groups(p<0.05).5 The correlation and regression analysis of observation index in T2DM groups5.1 The level of blood serum HGF,IL-6 was positively correlated with course of diabetes mellitus,HbA1c,LDL, SqTv and UAER,and it was negatively correlated with HDL,SqTs SDNN,SDNNindex,SDANNindex, rMSSD,PNN50,TP,VLF, LF, HF and the minimum value of frequency. There was also obvious positive correlation between the level of blood serum IL-6 and HGF.For blood serum HGF level as dependent variable, all of the influential factors as independent variable do a regression analysis,using the multiple stepwise method, UAER(r2=0.37),LDL(r2=0.15)fit into the regression equation. For blood serum IL-6 level as dependent variable,all of the influential factors as independent variable do a regression analysis, using the stepwise method, LDL(r2=0.16),FIB(r2=0.11)fit into the regression equation.5.2 The course of diabetes mellitus was negatively correlated with SDNN, SDNNindex, rMSSD, PNN50, TP, VLF, LF,HF and the minimum value of frequency.It also had correlation with SqTv, SqTs, UAER.5.3 SqTv was negatively correlated with SDNN, SDNNindex, SDANNindex, rMSSD, PNN50, TP, VLF, LF, HF and the minimum value of frequency. It also had correlation with UAER, SqTs, HDL. SqTs was positively correlated with SDNN,SDNNindex,SDANNindex, rMSSD,PNN50,TP,VLF, LF, HF and the minimum value of frequency. It also had correlation with HbA1c, Fib, UAER.6 The comparison of micrangium complicationsAmong 60 patients,there were 31,21,34 patients complicating with DN,DR,DPN. The result of chi-square criterion showed there were statistics differences in the three complications among A, B and C groups(p<0.05)Conclusion:(1)The level of blood serum HGF,IL-6 is much higher in T2DM than normal group,the more serious of the CAN is,the higher of blood serum HGF,IL-6 level is. Following the development of CAN,the diabetes mellitus micrangium complications such as DN,DR,DPN also increase. There is dependablity between blood serum HGF,IL-6 level and course of diabetes mellitus, HbA1c, LDL, HDL, UAER, SqTv, SqTs and the index of HRV. Detecting the level of blood serum HGF,IL-6 helped to comprehend the pathogenesy of CAN,give clinical guidance to prevention and cure CAN in earlier period by improving function of blood vessel endothelium.(2)Compared with normal group, the index of HRV obviously decrease in T2DM patients. This study adopt squatting test which is convenient, well complied and have the same mechanism with orthodox heart vascellum test. It also has a good dependability with the index of HRV which represent the function of sympathetic nerve and parasympathetic nerve.It is economical and practical and can be applied to sieve the CAN patients in T2DM. |
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