本文已被：浏览 117次 下载 147次
Received:January 29, 2026 Published Online:June 28, 2026
Received:January 29, 2026 Published Online:June 28, 2026
中文摘要: 目的 探讨糖尿病肾病（DKD）患者心率变异性（HRV）与载脂蛋白B/载脂蛋白A1比值（ApoB/ApoA1比值）在不同估算肾小球滤过率（eGFR）水平下的分层相关性，以期为该人群的心血管风险精准评估提供参考。方法 采用横断面研究，选取2022年1月至2024年6月江苏省省级机关医院收治的258例DKD患者作为研究对象。根据eGFR水平分为≥60组［eGFR≥60 mL/（min·1.73 m2），n=95］，30~<60组［eGFR 30~<60 mL/（min·1.73 m2），n=118例］和<30组［eGFR<30 mL/（min·1.73 m2），n=45］。各组患者行24小时动态心电图检查以分析HRV指标，同时收集ApoB/ApoA1比值。采用Spearman相关分析和多元线性回归分析探讨HRV与ApoB/ApoA1比值的关系。结果 三组患者在年龄、糖尿病病程、血清肌酐及尿蛋白/肌酐比值上差异均有统计学意义（P＜0.05）。随着eGFR下降，正常窦性心搏间期标准差（SDNN）降低（P＜0.01），eGFR每下降10mL/（min·1.73 m2），SDNN减少10.8 ms（P＜0.01）；相邻正常窦性心搏间期差值的均方根（RMSSD）同样呈下降趋势（P=0.003）。ApoB/ApoA1比值随eGFR下降而显著升高（P＜0.01）。相关性分析显示，SDNN与ApoB/ApoA1比值呈显著负相关（r=-0.381，P＜0.01），且该相关性在30~<60组（r=-0.356，P=0.001）和<30组（r=-0.487，P=0.003）亦有统计学意义。多元线性回归分析显示，eGFR（β=5.670，P＜0.01）和ApoB/ApoA1比值（β=-12.730，P=0.034）是SDNN的独立影响因素。结论 在DKD患者中，HRV与ApoB/ApoA1比值的负相关性随肾功能减退而显著增强，呈现明确的eGFR分层效应。监测ApoB/ApoA1比值或有助于对肾功能不全患者的心血管自主神经风险进行分层管理。
Abstract:Objective To investigate the stratified correlation between heart rate variability（HRV）and the apolipoprotein B/apolipoprotein A1（ApoB/ApoA1）ratio in patients with diabetic kidney disease（DKD）across different levels of estimated glomerular filtration rate（eGFR）, aiming to provide a reference for the precise assessment of cardiovascular risk in this population. Methods A cross-sectional study was conducted, selecting 258 patients with DKD admitted to Jiangsu Province Official Hospital from January 2022 to June 2024. Based on eGFR levels, patients were divided into the ≥60group［eGFR≥60 mL/（min·1.73 m2）, n=95］, the 30-<60 group［eGFR 30-<60 mL/（min·1.73 m2）, n=118］, and the <30group［eGFR<30 mL/（min·1.73 m2）, n=45］. 24-hour ambulatory electrocardiography was performed in all groups to analyze HRV parameters, and the ApoB/ApoA1 ratio was concurrently collected. Spearman correlation analysis and multiple linear regression analysis were used to explore the relationship between HRV and the ApoB/ApoA1 ratio. Results Statistically significant differences were observed among the three groups in age, duration of diabetes, serum creatinine, and urinary protein/creatinine ratio（P＜0.05）.As eGFR declined, the standard deviation of normal-to-normal intervals（SDNN）decreased（P＜0.01）, with SDNN decreasing by 10.8 ms for every 10 mL/（min·1.73 m2）reduction in eGFR（P＜0.01）；the root mean square of successive differences（RMSSD）also showed a downward trend（P=0.003）.The ApoB/ApoA1 ratio significantly increased with declining eGFR（P＜0.01）. Correlation analysis revealed a significant negative correlation between SDNN and the ApoB/ApoA1 ratio（r=-0.381, P＜0.01）, and this correlation was also statistically significant in the 30-<60 group（r=-0.356, P=0.001）and the <30 group（r=-0.487, P=0.003）. Multiple linear regression analysis showed that eGFR（β=5.670, P＜0.01）and the ApoB/ApoA1 ratio（β=-12.730, P=0.034）were independent influencing factors for SDNN. Conclusion In patients with DKD, the negative correlation between HRV and the ApoB/ApoA1 ratio strengthens significantly as renal function deteriorates, demonstrating a clear eGFR stratification effect. Monitoring the ApoB/ApoA1 ratio may be helpful for the stratified management of cardiovascular autonomic nerve risk in patients with renal insufficiency.
keywords: Diabetic kidney disease Heart rate variability Apolipoprotein Estimated glomerular filtration rate Stratified correlation Renal function
文章编号： 中图分类号：R587.2 文献标志码：A
基金项目:江苏省卫生健康委医学科研指导性项目（M2024266）；江苏省省级机关医院（南京医科大学附属老年医院）人才建设基金（IR2025102）
引用文本：