| Background and objectiveIn recent years,with the increasing incidence of type 2 diabetes,the prevalence of coronary heart disease and cardiac autonomic neuropathy has also increased.The pathogenesis of diabetes and its complications is complex,among which oxidative stress is one of the important mechanisms,and superoxide dismutase(SOD)is a class of metalloproteinases with obvious anti oxidative stress.The decrease of SOD level directly indicates the decline of anti oxidative stress function.In recent years,the relationship between the change of SOD level and type 2 diabetes and coronary heart disease has been paid more attention.Studies have shown that patients with coronary heart disease and diabetes have a certain degree of cardiac autonomic nervous function damage.Heart rate variability(HRV)is considered to be the most accurate indicator to reflect the function and dynamic balance of cardiac autonomic nervous system.Once type 2 diabetic patients with coronary heart disease,the occurrence of acute coronary syndrome can be painless,so how to find coronary heart disease in patients with type 2 diabetes is particularly important.At present,the diagnosis of coronary heart disease still depends on invasive examination coronary angiography.We aim to find a simple and noninvasive detection method to predict the occurrence of coronary heart disease,and SOD and HRV indexes are related to type 2 diabetes and coronary heart disease.Therefore,this study aims to analyze the changes of SOD and HRV indexes in patients with coronary heart disease and type 2 diabetes,and to study the characteristics of cardiac autonomic nerve injury and oxidative stress;At the same time,through the study of the relationship between the severity of coronary artery disease and SOD and HRV,to explore their clinical significance in predicting the occurrence of coronary heart disease.MethodsResearch subjects:a total of 610 patients who underwent coronary angiography in the Department of Cardiology of Affiliated Hospital of Yangzhou University from January to November 2020 were selected and divided into three groups according to the results of coronary angiography,previous history and blood glucose:1.Coronary heart disease with diabetes mellitus group(CHD+T2DM):208 patients with type 2 diabetes mellitus were diagnosed as coronary heart disease by coronary angiography;2.Simple coronary heart disease group(CHD):210 patients with coronary heart disease diagnosed by coronary angiography,without history of diabetes and were not diagnosed as type 2 diabetes;3.Normal control group(CK):192 patients were diagnosed as non coronary heart disease by coronary angiography,without history of diabetes and were not diagnosed as type 2 diabetes.All patients were excluded type 1 diabetes,acute infection,severe heart failure,acute cerebrovascular disease,tumor and so on.Research methods:1.Record all patients’ age,gender,systolic blood pressure,diastolic blood pressure,history of smoking and course of type 2 diabetes mellitus,at the same time measure height and weight,calculate body mass index(BMI);2.All patients were fasting for 12 hours.The next morning,fasting venous blood was collected from the clinical laboratory center of hospital to detect the biochemical indexes such as glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG),cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL)and superoxide dismutase(SOD).3.All patients were examined by 24-hour dynamic electrocardiogram before operation.HRV index was used to evaluate the damage characteristics of cardiac autonomic nerve,and the value was automatically calculated and generated by the matching software.4.Gensini score was used to evaluate the degree of coronary artery stenosis.The data were analyzed by spss22.0 statistical software.Results1、Comparison of basic characteristics among three groupsThe results of BMI,SBP,DBP and TC of the three groups were similar(P>0.05);the age,male proportion and smoking proportion of CHD group and CHD+T2DM group were significantly higher(P<0.05);the levels of FBG,HbAlc,TG and LDL in CHD+T2DM group were significantly higher than other two groups,while the levels of HDL were significantly lower(P<0.05).2、Comparison of SOD,HRV and Gensini score among three groupsSOD and HRV decreased and Gensini score increased in CHD and CHD+T2DM groups(P<0.05),SOD and HRV were lower and Gensini score was higher in CHD+T2DM group(P<0.05).3、Quartile analysis of Gensini scoreAccording to Gensini score,all patients with coronary heart disease were divided into four groups:low,medium,high and very high Gensini score groups.The age,blood pressure,BMI,TC,TG,LDL and HDL levels were similar among the groups(P>0.05).The male proportion,smoking proportion,duration of DM,FBG,HbAlc in the high and very high Gensini score groups were significantly higher than those in the other two groups(P<0.05),while the indexes of SOD and HRV were significantly lower(P<0.05).The course of DM,SOD,SDNN,SDANN,pNN50 in very high Gensini score group were significantly different from those in the high Gensini score group(P<0.05),and the SDNN values in the four groups were significantly different(P<0.05).4、Correlation analysis of Gensini score、SOD and other factorsGenisini score was positively correlated with duration of DM,FBG,HbA1c(P<0.05),and negatively correlated with SOD and HRV(P<0.05);SOD was negatively correlated with duration of DM,FBG,HbA1c(P<0.05),and positively correlated with SOD and HRV(P<0.05);5、ROC curve analysisThe duration of DM,SOD/SDNN were all significant for the diagnosis of coronary heart disease.The sensitivity(0.76)and specificity(0.69)of SOD/SDNN were the highest,which was the most significant for the diagnosis of coronary heart disease.4、Multiple linear regression analysis of Gensini score and other factorsGensini score was used as the dependent variable(Y),and stepwise regression m ethod was used to screen variables for multiple linear regression.The multiple linear regression equation Gensini’=127.75-0.31*(SOD)-0.28*(RMSSD)-0.13*(SDNN)-0.25*(S DANN)+1.86*(duration of DM)was constructed.Conclusion1.The antioxidant stress function of coronary heart disease patients decreased and the autonomic nerve was damaged.Type 2 diabetes mellitus could aggravate this trend.With the course of disease,the degree of autonomic nerve injury and coronary disease of heart disease was gradually aggravated.2.Combined detection of SOD、HRV indexes and the course of type 2 diabetes,can assess the severity of coronary artery disease and screen high-risk groups of coronary heart disease. |
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