Correlation Between Diabetes Cardiac Autonomic Neuropathy,Heart Rate Variability And IL-1,IL-6,TNF-?

Objective: 1.To evaluate the characeristics of Heart rate variability(HRV)in patients with Diabetic Cardiovascular Autonomic Neuropathy(DCAN);2.To investigate the influence of serum level of IL-1,IL-6 and TNF-? on DCAN;3.To explore the realted factors of DCAN and to illustrate the possible pathgenesis of DCAN.Method: 1.Date collection: Experimental group(DM group),124 patients with T2 DM in the Department of Neurology of Tian Jin medical univercity matebolic disease hospital(from september,2013 to april,2014)were investigated,other 49 cases of healthy were selected as normal control group(NC group).General clinical data,biochemical idexes of venous blood,levels of serum IL-1,IL-6,TNF-? were collected and measured;2.Twenty-four hour continous ECG recordings were also performed on all subjects.According to with or without abnormal HRV,DM group was divided into DCAN group(69 patients)and NDCAN group(55 patients);3.One-way ANOVA were used to analyzed the measurement data and Chi-square test was used to analyzed the categorical data.The related factors of DCAN were conducted by means of Multivariable adjusted Logistic regression model.Result:1.Level of IL-1 was positively correlated with ages,duration of disease,BMI,WHR,Hb A1 c,FPG,Cr,UMA and negatively associated with SDNN,SDANN,LF,HF,LF(NORM);Level of IL-6 and TNF-? were positively correlated with ages,durition of disease,BMI,WHR,Hb A1 c,FPG,Cr,UMA and negatively correlated with e GFR,SDNN,SDANN,LF,HF,LF(NORM),LF/HF(P<0.05);2.Ages,BMI,WHR,FPG,Hb A1 c,UMA,LDL,e GFR of DCAN group were significantly higher than those of NC group.Compared with NC group,NDCAN group exhibited higher Ages,BMI,WHR,FPG,Hb A1 c,UMA and e GFR.DCAN group in UMA,diabetes course of disease,prevalence of DR and DKD were significantly higher than NDCAN group(P<0.05);3.Among DCAN group,NC group and NDCAN group,DCAN group exhibated highest level of IL-1,IL-6 and TNF-?.Level of IL-6 and TNF-? of NDCAN group were significantly higher than those of NC group(P<0.05);4.SDNN,SDANN,LF,HF,LF(norm),LF/HF of DCAN group were significantly lower than those of NC group.SDNN,SDANN,RMSSD,LF,HF,LF(norm),HF(norm),LF/HF of NDCAN group were significantly lower than those of NC group.Compared with NDCAN group,DCAN group exhibitied lower SDNN,SDANN,RMSSD,LF,HF,LF(norm)and HF(norm)(P<0.05);5.Multivariable adjusted Logistic regression showed that duration of disease,UMA,IL-1,IL-6,TNF-? were the risk factors of DCAN patients and SDNN was the protective factor of DCAN patients;6.According to the tertiles of total UMA,All datas were categorized into lower,medium and high groups(UMA1?UMA2?UMA3).There were an increasing tendency in the level of IL-1,IL-6,TNF-?and a decreasing tendency in SDNN,SDANN,RMSSD,LF,HF,LF(norm),LF/HF among the groups(P<0.05);7.The levels of IL-1,IL-6 and TNF-? were divided into 1: 4 group and IL-1,IL-6 and TNF-?,respectively.The levels of IL-1,IL-6 and TNF-?(P<0.05),while SDNN,SDANN,LF,HF and LF were decreased,and the differences were statistically significant(P<0.05).Conclusion: 1.Inflammatory factors IL-1,IL-6,TNF-alpha are closely related to the pathogenesis of DCAN;2.The HRV index of group DCAN generally declined,while HF(NORM)may be earlier than other indicators;3.Duration of disease,UMA,IL-1,IL-6,TNF-? were the risk factors of DCAN patients,SDNN was the protective factor of DCAN patients;4.DCAN is associated with T2 DM microvascular complications.The inflammatory factors IL-1,IL-6 and TNF-? are closely related to the pathogenesis of DKD.