Screening For Cardiovascular Autonomic Neuropathy And Predicting Adverse Outcomes In Community Residents With SUDOSCAN

Part?Cross-sectional Study of Screening Diabetic Cardiovascular Autonomic Neuropathy in Zhongqi Community BackgroundDiabetes mellitus(DM)is a disease characterized by chronic hyperglycemia,but its harm is not only the elevation of blood glucose but also the cardiovascular disease caused by hyperglycemia,thereby increasing the mortality rate.In the common complications of diabetes,cardiovascular autonomic neuropathy(CAN)can clearly increase the incidence of cardiovascular disease and mortality in diabetes.However,due to the lack of a unified diagnostic criteria and practical screening methods,CAN is currently the most frequently neglected clinical complications that lead to serious consequences.Therefore,it is imperative to seek simple and easy screening methods.PurposeIn the community of diabetics,CAN was diagnosed by short-range heart rate variability(HRV)testing,and the SUDOSCAN method was used to investigate the screening efficacy of CAN.MethodThe subject of this study was part of the 2014 follow-up of the national epidemiological "REACTION,study.It was from the Zhongqi's employee community.A total of 184 elderly people over the age of 40 were initially included,based on important data.Missing and entry criteria,the final inclusion of 87 subjects became the observation population.Observed populations were divided into diabetic group(n=50)and control group(n=37)according to oral glucose tolerance test results and past diabetes history.There was no difference in age and gender between the two groups.All subjects completed short-range HRV,SUDOSCAN,and the Autonomic Symptom Scale(SAS).According to the results of short-range HRV frequency domain analysis,at least two abnormalities can be used to diagnose CAN;SUDOSCAN observations include:average electrophysiology of both hands and feet.Sweat conductivity(ESC)and cardiovascular autonomic neuropathy risk index(CAN-RS);SAS symptom scores were used to assist in assessing CAN symptoms.All data were statistically analyzed using SPSS 17.0 software.Result1.Using short-range HRV to diagnose CAN,the detection rate of CAN in diabetic group was significantly higher than that in control group(30%vs 10.8%,P=0.032);Autonomic Symptom Scale(SAS)screened for CAN symptoms,and diabetes group scored significantly higher In the control group(9.5 ± 5.0 vs 6.5 ± 4.6,p = 0.006),it was shown that the prevalence of CAN in diabetics was increased and the symptoms were obvious.2.The SUDOSCAN test found that the average ESC and mean ESC in both hands of CAN patients were significantly lower than those in non-cardiovascular autonomic neuropathy(50.2±22.2 ?Si vs.61.5±17.2 ?Si,P=0.022 and 51.2±23.1 ?Si vs.65.0±19.0 pSi,P=0.009),and the CAN-RS was significantly elevated(62.4 ± 11.6 vs 25.0 ± 14.8,p<0.001).3.According to the diagnosis of CAN,the use of binary logistic regression analysis found that CAN-RS[OR=1.029(1.012-1.046),P=0.0008]is a relatively independent risk factor for CAN incidence after adjusting for age and other related factors.4.The short-range HRV was used as the diagnostic standard of CAN to draw the ROD curves of the SODUSCAN measurement and SAS symptom scores.The test efficacy of CAN-RS,average ESC of both hands,and average ESC of both feet was statistically significant.The area under the curve is 0.7392,0.6846,and 0.656(p=0.002,p=0.014,and P=0.038),and the corresponding cut-point values are 26.25,75.34 ?Si,and 63.69 ?Si,respectively.5.CAN-RS screening for CAN was the best among the study population.When CAN-RS was greater than 26.25,the risk of CAN increased.The sensitivity was 78.95%,the specificity was 66.18%,and the Yoden index was 0.45.ConclusionSUDOSCAN technology can effectively screen diabetic heart autonomic neuropathy.When the cardiovascular autonomic nerve risk index is greater than 26.25,the diagnostic efficiency is better.The area under the curve is 0.7392,the sensitivity is 78.95%,and the specificity is 66.18%.Part ?Screening of Shantui Community Metabolic Syndrome and Predicting Association between Cardiovascular Autonomic Neuropathy and Poor PrognosisBackgroundMetabolic syndrome(MS)is a syndrome of multiple chronic metabolic disorders.With the change of lifestyle,more than one quarter of the world suffers from MS.Previous studies have confirmed that MS can significantly increase the risk of adverse outcomes such as diabetes,cardiovascular and cerebrovascular diseases,stroke,and death.Early screening for MS and prediction of high-risk groups with possible adverse cardiovascular outcomes may prevent early adverse events,but there is currently a lack of reliable and accurate predictors.In recent years,a cross-sectional study using the Framingham cardiovascular risk score to fit the risk of cardiovascular disease for ten years as a research indicator has been conducted.However,the cohort study of cardiovascular events and death as a study of prognosis is very limited.Cardiovascular autonomic neuropathy(CAN)is a disease that easily causes cardiovascular failure such as painless myocardial infarction.The incidence of this disease is significantly higher in patients with diabetes,and studies in the metabolic syndrome population are still insufficient.Due to the cumbersome operation of diagnostic criteria and lack of simple screening methods,CAN has become a frequently overlooked disease in clinical diagnosis and treatment.SUDOSCAN detection is a function of evaluating autonomic nerve function by detecting sweating function.It has the characteristics of non-invasive,rapid(2 minutes),simple and objective.It is currently used for diabetes prediction and complication screening,and its application in metabolic syndrome is still less.In the first part,it has been confirmed that the SUDOSCAN-detected CAN-risk index(CAN-RS)can effectively screen diabetic CAN,but CAN status and CAN-RS in the metabolic syndrome population can be used as predictors of poor prognosis of cardiovascular events,the study.PurposeThis study established a cohort of community cohorts.Cardiovascular and cerebrovascular events and all-cause deaths were used as endpoints to screen for influencing factors associated with poor prognosis.SUDOSCAN was used to screen for metabolic syndrome and cardiovascular autonomic neuropathy.The predictive value of poor event outcomes provides a reliable evidence base for discovering screening indicators that are simple and predictive.MethodThe study participants came from the national epidemiology "REACTION" research center located in the screening center set up by the Shantui Community Health Service Center in Jining City,Shandong Province.The main observations were residents in the three living quarters within its jurisdiction who were older than 40 years old.In February 2012,a total of 4572 people were screened at the screening site,and 3,503 subjects were finally included in the observation cohort according to the entry and exit criteria.The first follow-up was conducted from July to August 2014.There were 17 end-point events.A total of 2056 people completed the actual measurement and follow-up at the site.A second follow-up was conducted in November 2016.1780 telephone follow-ups were successful,including 44 end-point events.From 2012 to 2016,a total of 4.75 years of follow-up,a total of 1797 people completed a complete follow-up,the occurrence of a total of 61 primary end points,the total number of 852 people lost,the total loss of visit was 24.3%.All of the data in this study were statistically analyzed.All subjects participating in the study had signed informed consent.The study used the Joint Statement jointly issued by five joint organizations in 2009 as the criteria for diagnosing MS and was divided into MS group and non-MS group.SPSS 17.0 software and R language software were used for statistical analysis(same as the first part).A multivariate logistic regression model was used to analyze risk factors,linearity tests were used to analyze the linear relationship between the two variables,covariate diagnosis and covariate screening were used to determine the covariates that had greater impact,and interactions were used to test the interactions between variables.Results1.The prevalence of baseline metabolic syndrome was 48.97%,the prevalence of diabetes was 23.15%,and prediabetes prevalence was 9.4%.After 2.5 years of on-site follow-up,the prevalence of MS was 51.84%and the prevalence of DM was 26.03.%The prevalence of prediabetes was 20.1%,predominantly impaired glucose tolerance in prediabetes.2.More than 60%of newly diagnosed MS patients had increased waist circumference and increased blood pressure at baseline.After follow-up,the ratio of triglyceride and high-density lipoprotein increased most significantly(19.9%vs 72.7%and 9%vs 70.6).%,P<0.001)to reach the diagnostic criteria.People with MS risk factors should pay attention to controlling blood lipids and intervene early.3.The CAN risk was higher in the MS group than in the non-MS group.The CAN-RS(33.3±11.5 vs 27.8±12.2,P<0.001)was more effective than the hand-foot average conductivity screening.4.According to the CAN-RS divided into three groups,the MS incidence(P for trend<0.001)and the new MS rate(P=0.0008),the incidence of end events(P=0.0306)are increased with the increase in the risk of CAN However,the rate of new-onset diabetes has not changed much.5.According to the MS component analysis,there was a significant difference between different groups of cardiovascular autonomic neuropathy in the MS group,with significant differences in end-point events[OR=10.15(2.12,48.63),P=0.0037];but in non-MS group CAN The difference was not statistically significant.After further applying the interaction test to adjust the same covariates,there was no statistically significant difference in the end point events between different MS strata in the CAN group(p=0.8899 for interaction),so there was no need for MS stratification discussions.6.After adjustment for related confounding factors in the total follow-up population,the risk of end point events in the high-risk cardiovascular autonomic neuropathy group was 9.37 times that of the normal group with cardiovascular autonomic neuropathy[OR=9.37(2.77,31.69),p=0.0003].Conclusion1.The prevalence of metabolic syndrome and diabetes are high in Jining.Central obesity and hypertension are the main components.High-risk groups need early intervention in blood lipids to prevent the occurrence of metabolic syndrome.2.The higher the risk index of cardiovascular autonomic neuropathy screened by SUDOSCAN,the higher the incidence of metabolic syndrome.3.The increased risk index of cardiovascular autonomic neuropathy is an independent predictor of adverse prognostic events in the later period,and the risk of adverse prognosis in the high-risk group is 9.37 times that of the normal group[OR=9.37(2.77,31.69),p=0.0003].Part ?Relationship between structural changes of intestinal flora and diabetic cardiovascular autonomic neuropathyBackgroundIntestinal flora is a new target for the regulation of metabolic diseases in the human body.Intestinal microbes not only control host metabolism through intestinal mucosal immunity,metagenomics,and other molecular pathways,causing metabolic diseases such as diabetes,obesity,and metabolic syndrome,but also affect the intestinal nervous system(a separate branch of the autonomic nervous system)through metabolites.The sympathetic and parasympathetic nerves connect the neuroendocrine system and the human advanced central nervous system,thereby forming the "intestinal microbiota-brain axis." This axis perfectly correlates the gut microbiota,autonomic nervous system and endocrine and metabolic diseases.These three intrinsic associations have high research value and space,and may also be used for future treatment and intervention of metabolic diseases.Diseases provide new research directions and ideas.Diabetic cardiovascular autonomic neuropathy(CAN)has abnormal glucose metabolism and small nerve injury.Changes in structure and function of intestinal microbiota may change the host's glucose metabolism,and may affect the activity of the enteric nervous system through its metabolites.Therefore,whether the difference in intestinal flora is also a possible mechanism of autonomic neuropathy in diabetic patients and an intervening target,there are few studies at present.PurposeObserve SUDOSCAN technique to evaluate the relationship between diabetic autonomic neuropathy and intestinal microflora structureMethodThis study collected fecal specimens of 50 patients with type 2 diabetes admitted to the Department of Endocrinology at the Qilu Hospital of Shandong University from May 1,2016 to October 1,2016.A total of 43 diabetic patients were successfully tested(DM group);Similar healthy volunteers without chronic diseases such as hypertension,diabetes,coronary heart disease and other 33 cases of feces were recorded as control group.All subjects who took probiotics within the last 2 weeks or those who used antibiotics within the last week or who had severe liver and kidney insufficiency were excluded from the study.The study was approved by the Ethics Committee of Qilu Hospital of Shandong University.All participants signed informed consent and completed OGTT,SUDOSCAN and 16S rDNA amplicon sequencing.SUDOSCAN detected autonomic neuropathy risk index(CAN-RS),less than 25 was recorded as non-CAN group,25-50 was recorded as low-risk group,and 50 was higher-risk group,all data were analyzed using SPSS 17.0 software and R Languages are analyzed statistically.Results1.The glycometabolism index and glomerular filtration rate of the DM group were higher than those of the control group(p<0.001 and P=0.009).The resting heart rate in the DM group was higher than that in the control group(82.1 ± 12.9 vs 76.8 ± 9.4,p=0.048),and the CAN-RS was significantly higher(39.6 ± 17.5 vs.13.0 ± 6.7,p<0.001).Both showed that there was autonomic nerves in the diabetic group.Dysfunction.2.When comparing DM group with control group,the abundance of three Alpha diversity analysis methods(Shannon index,Simpson index,observed-species index)was significantly lower than that of the control group;Beta diversity analysis suggested that the difference between the two groups was greater than that of the group.Internal difference(P=0.001).Species level analysis revealed that Prevotella had the most significant abundance change between the two groups,and the abundance in the DM group decreased significantly(p=0.00037).3.Compared with the different risk groups of diabetes CAN,with the increase of CAN-RS index,the resting heart rate gradually increased(p=0.042),suggesting that the symptoms of cardiovascular autonomic neuropathy increased.4.Comparing the different risk groups of diabetes CAN with the composition of the control group,the Alpha diversity analysis(Shannon index and Simpson index)of the two methods showed that,except for the increase in the bacterial richness of the CAN high-risk group,the other two groups Both were significantly lower than the control group.Beta diversity analysis showed that the difference between the four groups was greater than the difference within the group(P=0.003).5.Species composition analysis was performed in different CAN risk groups for diabetes:At the level of the gate,the ratio of Bacteroidetes/Thymophyta(BF)was lower in the control group(P=0.081).There are significant differences in the composition of the bacterial flora at the genus level.The most significant are the genus Roche and Caprichella,both of which are enriched in the control group and have a positive correlation.E.coli and Enterococcus were relatively enriched in the CAN high-risk group of diabetes,and the abundance of lactic acid bacteria increased with the increased risk of CAN in diabetes,and were significantly higher than those in the control group and may be related to the pathogenesis of diabetes and autonomic disorders..Conclusion1.The intestinal flora composition and structural biodiversity of diabetic patients were lower than normal population,among which the abundance of Prevotella was the most significant decline,and the number of lactic acid bacteria in normal people was extremely low,but it was higher in diabetes.2.There are significant differences in the composition of bacterial flora in different groups of diabetic CAN risk groups,among which the enrichment in healthy people is positively related to genus Robustia and furomyces,and the genus Escherichia is enriched in non-CAN group of diabetes;Enterobacteriaceae and Aedes species were enriched in the CAN high-risk group.The abundance of lactic acid bacteria increased with the increased risk of CAN in diabetes and was significantly higher than that of the control group.