Research On The Relationship Between TCM Syndrome Types And Heart Rate Variability And Lipid Metabolism In T₂DM

Objective:1.To study the relationship between TCM syndrome types and heart rate variability in type 2 diabetic patients.2.To analyze the correlation among TCM Syndrome types,heart rate variability and lipid metabolism in type 2 diabetic patients.Methods:To select cases of type 2 diabetes patients who were admitted to the Department of Endocrinology of Yunnan Provincial Hospital of Traditional Chinese Medicine from December 2016 to January 2018,and collect candidate data for general information and four consultations to determine the type of TCM syndrome,and then test candidates’s blood glucose,blood lipids and other biochemical indicators,and monitoring HRV indicators and analyzing the relevant indicators by using the application of 24-hour Holter.Results:1.A total of 222 cases are included in this study,including 103 males（46.40%） and 119 females（53.60%）.The ratio between males and females is approximately1:1.2;the youngest is 38 years old and the oldest is 85 years old.The data do not match.Normal distribution,using the median and interquartile range:64.5（55.00,73.00）;body mass index（kg/m2）:minimum 14.08 kg/m2,maximum 33.78kg/m2,average:24.60±3.39 kg/m2.The distribution of TCM syndromes in 222patients with T₂DM is 77 cases（35.00%）with deficiency of both qi and yin,46 cases（20.91%）with liver-kidney yin deficiency syndrome,and 45 cases（20.45%）with spleen-stomach damp-heat syndrome.Deficiency is found in 44 cases（20.00%）and in10 cases（4.55%）.There is no significant difference in age,body mass index,and disease course between Type 2 diabetes mellitus（T₂DM）patients with different syndromes（p>0.05）.Gender has an influence on the distribution of TCM syndromes（p<0.05）.2.There is no significant differences in biochemical indicators of Fasting plasma glucose（FPG）,Hemoglobin A1c（HbA1c）,Glycated Serum Protein（GSP）,Triglyceride（TG）,Cholesterol（CHOL）,High density lipoprotein（HDL-C）and TCM syndromes（p>0.05）.Compared with patients with spleen-stomach damp-heat syndrome and liver-kidney yin deficiency syndrome,LDL-C is in the liver-kidney yin deficiency.The patients with high syndromes have statistically significant differences（p<0.05）.3.In the time domain analysis of Heart rate variability（HRV）,Standard deviation of the mean of NN interval（SDANN）,The mean square root of adjacent NN interval（RMSSD）,and trigonometric index has statistically significant differences in patients with different TCM syndromes（p<0.05）;The standard deviation of NN interval（SDNN）has no statistical significance in TCM syndrome patients（p>0.05）.Analysis of HRV frequency domain parameters:there is a statistically significant difference in Hinh-frequency（HF）among patients with different TCM syndromes（p<0.01）.There is no significant difference in Low-frequency（LF）,Very Low-frequency（VLF）between patients with different syndromes（p>0.05）.4.（1）In patients with T₂DM,SDNN is negatively correlated with TG（r=-0.148,p<0.05）,and there is a significant positive correlation between SDNN and HDL-C（r=0.227,p<0.01）.There is no linear correlation found between SDNN and CHOL,LDL-C（p>0.05）.（2）In patients with T₂DM deficiency of both qi and yin,SDNN is negatively correlated with TG,CHOL,and LDL-C（p<0.05）,whereas no correlation is found between SDNN and HDL-C（p>0.05）;patients with spleen-stomach damp-heat syndrome are found a positive correlation between SDNN and HDL-C（r=0.329,p<0.05）.No correlation is found between HRV and lipid metabolism in other syndromes（p>0.05）.Conclusions:1.The distribution of TCM syndromes in this case included:Qi and Yin deficiency and phlegm syndrome>liver and kidney yin deficiency syndrome>Spleen and Stomach Damp-Heat Syndrome>Qi and Yin Deficiency Syndrome>Hyperactivity of Lung Syndrome.2.Different syndromes of T₂DM patients have different impairments of their cardiac autonomic function.Among them,patients with liver-kidney yin deficiency syndrome have weaker sympathetic nerve activity than patients with deficiency of both qi and yin;patients with spleen-stomach damp-heat syndrome are less active than qi and yin deficiency.Diabetes patients may develop vagal and sympathetic nerve dysfunction early in life.As the disease progresses,the function of vagus nerve and sympathetic nerve in patients with diabetes can be substantially irreversible,reminding us that in the treatment of diabetes,early attention should be paid to the prevention and treatment of diabetes.3.T₂DM patients with dyslipidemia have an effect on autonomic nerve function,and elevated TG and decreased HDL-C may lead to（or increase）cardiac neurological dysfunction,especially in patients with Qi-yin deficiency and spleen-stomach damp-heat syndrome.