Tip 2 Diabetes Mellituslu Hastalarda Kardiyak Otonomik Nöropati ve Plasma Homosistein Seviyesi Arasındaki İlişki

Abstract

Giriş: Kardiyak otonomik nöropati (KON) diyabetik hastalarda artmış morbidite ve mortalitenin önemli bir sebebidir. Bu çalışmadaki amacımız diyabetik hastalarda plasma homosistein seviyesi ve anormal kalp hızı toparlanma indeksiyle belirlenen KON arasındaki ilişkiyi incelemektir.

Hastalar ve Yöntem: Bu çalışmaya koroner arter hastalığı şüphesiyle efor testi istenen 35 diabetes mellitus  (DB) hastası alındı. KON tanısı için kalp hızı toparlanma indeksinin ≤ 21 olması kabul edildi.

Bulgular: Çalışmaya dahil edilen tip 2 diyabetik hastalar normal kalp hızı toparlanma indeksi olanlar (> 21, n= 19) ve anormal kalp hızı toparlanma indeksi olanlar (≤ 21, n= 16) olmak üzere 2 gruba ayrıldı. Gruplar arasında klinik değişkenler, laboratuvar verileriyle yaş, hipertansiyon, hiperlipidemi ve sigara gibi risk faktörleri açısından farklılık yoktu. Ancak anormal kalp hızı toparlanma indeksi olan hasta grubunda homosistein seviyesi ve diyabet süresi normal kalp hızı toparlanma indeksi olan gruba göre anlamlı derecede yüksek bulundu (17.94 ± 5.91 umol/L’e karşı 13.27 ± 2.75 umol/L, p= 0.009 ve 10.06 ± 6.20’ye karşı 6.21 ± 4.87,     p= 0.048, sırasıyla). Homosistein seviyesi ve anormal kalp hızı toparlanma indeksi arasındaki ilişki diğer değişkenlerden bağımsızdı [Odds oranı 1.319 (%95 CI: 1.011-1.721), p= 0.041]. Homosistein seviyesi ve kalp hızı toparlanma indeksi arasında istatistiksel olarak anlamlı negatif korelasyon izlendi (r= -0.382, p= 0.024).            ≥ 15.02 umol/L homosistein değerinin anormal  kalp hızı toparlanma indeksini belirlemede sensitivitesi %75, spesifitesi ise %63.2 olarak bulundu.

Sonuç: Tip 2 diyabetik hastalarda plasma homosistein seviyesi ve kalp hızı toparlanma indeksi arasında negatif korelasyon gösteren anlamlı bir ilişki mevcuttur. Diyabetik hastalarda KON’un gelişimi ve takibinde homosistein seviyesinin değerlendirilmesi yardımcı olabilir.

Keywords

• Tip 2 diabetes mellitus,kardiyak otonomik nöropati,kalp hızı toparlanma indeksi

Association between Cardiac Autonomic Neuropathy and Homocysteine Level in Patients with Type 2 Diabetes Mellitus

Abstract

Introduction: Cardiac autonomic neuropathy is an important cause of increased morbidity and mortality in patients with diabetes mellitus. The aim of this study was to investigate the association between plasma homocysteine level and cardiac autonomic neuropathy assessed using the abnormal heart rate recovery index in patients with type 2 diabetes mellitus.

Patients and Methods: Thirty-five patients with type 2 diabetes mellitus who underwent an exercise stress test were included in the study. Abnormal heart rate recovery index was defined as ≤ 21 beat/min, which indicated cardiac autonomic neuropathy.

Results: Patients with type 2 diabetes mellitus were divided into two groups, that is, patients with a heart rate recovery index of > 21 beat/min and those with a heart rate recovery index of ≤ 21 beat/min. Clinical variables, laboratory variables and risk factors, such as age, hypertension, hyperlipidemia and smoking, were not different between the groups. However, the homocysteine level and duration of type 2 diabetes mellitus were significantly higher in patients with ≤ 21 beat/min than in those with > 21 beat/min (17.94 ± 5.91 umol/L vs 13.27 ± 2.75 umol/L, p= 0.009 and 10.06 ± 6.20 umol/L vs 6.21 ± 4.87 umol/L, p= 0.048, respectively). The homocysteine level was independently associated with the abnormal heart rate recovery index [odds ratio, 1.319 (95% CI, 1.011-1.721); p= 0.041] The homocysteine level was negatively correlated with the heart rate recovery index (r= -0.382, p= 0.024). The homocysteine cut-off value, indicating an abnormal heart rate recovery, was ≥ 15.02 umol/L, with 75% sensitivity and 63.2% specificity.

Conclusion: There was an independent association with a negative correlation between the plasma homocysteine level and abnormal heart rate recovery index in patients with type 2 diabetes mellitus. 

Keywords

• Type 2 diabetes mellitus,cardiac autonomic neuropathy,heart rate recovery index

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