| Background and PurposeVentricular premature contraction(PVC)in patients with diabetes is the most common arrhythmia,can be subjected to ischemia,hypoxia,electrolyte disorder,mechanical stimulation,autonomic nerve tension changes.PVCs are divided into different original sites according to the different forms characteristics of QRS waves in the surface electrocardiogram(ECG).Diabetes mellitus is a chronic metabolic disease which is serious harm to human health.Blood glucose is high due to the lack of insulin or insulin resistance,long-term hyperglycemia injuries heart,brain,kidney and other organs and systems,and associated with infection,ketoacidosis,hyperosmolar coma and so on,even malignant arrhythmia.According to the WHO diagnostic criteria for diabetes,diabetes is divided into type 1 diabetes,type 2 diabetes,gestational diabetes and other types,type 2 diabetes is the most common type and the age of onset is more than 40 years old.The disorder of autonomic nerve function in patients shows heart rate turbulence(HRT)and heart rate deceleration runs(DRs)change in ECG.The object of this study was the elderly patients with type 2 diabetes with frequent PVCs,through the comparative analysis on the characteristics of HRT and DRs in different sites of PVCs,providing reliable electrical basis for rational clinical care and symptomatic treatment,and improving the quality of life of patients with diabetes.Objects and methods1 Objects of studyAnalysed the examination results of 24 hours dynamic electrocardiography in elderly patients with type 2 diabetes retrospectively from September 2013 to December 2014 in the Second Affiliated Hospital of Zhengzhou University.Among them,according to the diagnostic standard of PVC,patients with frequent unifocal PVCs(138 cases)were in the research group,76 cases were male,62 female,aged 74.1 ± 9.2 years.All of the selected patients with type 2 diabetes were consistent with WHO diagnosis standard in 1999.Meanwhile,we also selected 102 cases of healthy elderly subjects with PVCs were found in the same period in our hospital ECG examination as the control group,male 58 cases,female 44 cases,aged 71.3 ± 9.6 years old.The two groups were excepted for pacemaker implantation,cardiac function II,III,IV grade(NYHA grade),and without the use of diuretics,arrhythmogenic and affecting the autonomic nervous system drugs within 1 week.There was no difference between the two groups in gender,age and so on(P >0.05).2 Instrument selectionAll participants were monitored with 24 hours of continuous dynamic electrocardiography produced by the United States DMS company and the wearing time was not less than 22 hours,all the results were reviewed and modified by professionals through the man-machine dialogue,excluding electrocardiogram with atrial flutter and atrial fibrillation,atrioventricular block and so on,and the whole of PVCs were divided into different origin sites according to the diagnostic criteria of the location of PVCs.The frequency of PVCs,heart rate turbulence index(TO,TS)and heart rate deceleration runs index(DRs)of each site were analysed and calculated by ECG analysis software of the DMS company.3 Statistical methodsAll data were analyzed by SPSS17.0 statistical software,count data using%,measurement data using ?±s.The count data adopted?2 test,and measurement data adopt homogeneity of variance t test,P < 0.05 for the difference was statistically significant.Results1 The 24 hours frequency of PVCs : the diabetic group was significantly higher than the normal group(1229.67±506.19vs217.09±161.79.p<0.05).2 The rate of PVCs origined from left ventricular apex in the diabetic group were higher than the naomal group(15.2%vs3.0%.p<0.05),and the PVCs origined from the right ventricular outflow tract lower than the normal group(39.9%vs60.7%.p<0.05).The PVCs origined from the right ventricular outflow tract were higher than the other in two groups(39.9%vs21.7%,15.2%,12.3%.60.7%vs22.5%,3.0%,6.9%.All p<0.05).3 The abnormal rate of TO,TS and DRs in the diabetic group were higher than the normal group(TO:29.0%vs10.8%.TS:37.0%vs16.7%.DRs:26.8%vs12.7%.All p<0.05).4 In the diabetic group,the abnormal rate of TO,TS,DRs originating from the left ventricular were higher than the right ventricle,the abnormal rate of TO,TS,DRs originating from left ventricular outflow tract was the highest in the four origins(TO:60.0%vs14.3%,25.5%,29.4%.TS:80.0%vs19.0%,32.7%,29.4%.DRs:53.3%vs23.8%,21.8%,23.5%.All p<0.05).ConclusionsIn elderly patients with type 2 diabetes,the occurrence frequency of different original PVCs,HRT,DRs are significantly different with healthy people.The PVCs origined from left ventricular apex in the diabetic group are significantly higher than the normal group,meanwhile,the abnormal rate of HRT and DRs from left ventricular outflow tract are higher than right ventricular outflow tract,right ventricular apex and left ventricular apex.It is suggested that elderly patients with type 2 diabetes mellitus combined with left ventricular outflow tract premature beats are more likely to have malignant arrhythmia. |
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