Some studies have suggested that patients with diabetes and foot complications have worse cardiovascular and cerebrovascular risk profiles, higher degrees of endothelial dysfunction and arterial stiffness and a higher inflammatory background than patients with diabetes without diabetic foot complications. Patients with diabetes mellitus have an alteration in the sympathovagal balance as assessed by means of heart rate variability (HRV) analysis, which is also related to the presence of endothelial dysfunction. Other studies suggest a possible role of inflammation coexisting with the alteration in the sympathovagal balance in favor of the atherosclerotic process in a mixed population of healthy subjects of middle and advanced age. The aim of this study was to evaluate the degree of alteration of sympathovagal balance, assessed by HRV analysis, in a cohort of patients with diabetes mellitus with diabetic foot and in control subjects without diabetic foot compared with a population of healthy subjects and the possible correlation of HRV parameters with inflammatory markers and endothelial dysfunction indices. We enrolled all patients with diabetic ulcerative lesions of the lower limb in the Internal Medicine with Stroke Care ward and of the diabetic foot outpatient clinic of P. Giaccone University Hospital of Palermo between September 2019 and July 2020. 4-h ECG Holter was performed. The following time domain HRV measures were analyzed: average heart rate, square root of the mean of successive differences of NN (RMSSD), standard deviation or square root of the variance (SD), and standard deviation of the means of the NN intervals calculated over a five-minute period (SDANN/5 min). The LF/HF ratio was calculated, reactive hyperemia was evaluated by endo-PAT, and serum levels of vaspine and omentin-1 were assessed by blood sample collection. 63 patients with diabetic foot, 30 patients with diabetes and without ulcerative complications and 30 patients without diabetes were enrolled. Patients with diabetic ulcers showed lower mean diastolic blood pressure values than healthy controls, lower MMSE scores corrected for age, lower serum levels of omentin-1, lower RHI values, higher body weight values and comparable body height values, HF% and LF/HF ratio values. We also reported a negative correlation between the RHI value and HRV indices and the expression of increased parasympathetic activity (RMSDD and HF%) in subjects with diabetic foot and a statistically significant positive correlation with the LF/HF ratio and the expression of the sympathovagal balance. Patients with diabetic foot show a higher degree of activation of the parasympathetic system, expressed by the increase in HF values, and a lower LF/HF ratio. Our findings may corroborate the issue that a parasympathetic dysfunction may have a possible additive role in the pathogenesis of other vascular complications in subjects with diabetic foot.

中文翻译：

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评估患有和不患有糖尿病足的 2 型糖尿病受试者的心率变异性 (HRV)：与内皮功能障碍指数和脂肪炎症功能障碍标志物的相关性

一些研究表明，与没有糖尿病足并发症的糖尿病患者相比，患有糖尿病和足部并发症的患者具有更差的心脑血管风险、更严重的内皮功能障碍和动脉僵硬度以及更高的炎症背景。通过心率变异性 (HRV) 分析评估，糖尿病患者的交感迷走神经平衡发生改变，这也与内皮功能障碍的存在有关。其他研究表明，炎症可能与交感迷走神经平衡的改变共存，以促进中老年健康受试者混合人群的动脉粥样硬化过程。本研究的目的是通过 HRV 分析评估交感迷走神经平衡的改变程度，在一组患有糖尿病足的糖尿病患者和没有糖尿病足的对照受试者中，与健康受试者进行比较，以及 HRV 参数与炎症标志物和内皮功能障碍指数的可能相关性。我们招募了 2019 年 9 月至 2020 年 7 月期间在巴勒莫 P. Giaccone 大学医院卒中内科病房和糖尿病足门诊的所有下肢糖尿病溃疡性病变患者。进行了 4 小时心电图动态心电图检查。分析了以下时域 HRV 测量值：平均心率、NN 连续差均值的平方根 (RMSSD)、标准差或方差的平方根 (SD)，以及计算出的 NN 间隔均值的标准差超过五分钟（SDANN/5 分钟）。计算 LF/HF 比值，通过内膜 PAT 评估反应性充血，并通过血样收集评估 vaspine 和 omentin-1 的血清水平。糖尿病足患者63例，糖尿病无溃疡并发症患者30例，无糖尿病患者30例。糖尿病溃疡患者的平均舒张压值低于健康对照组，MMSE 评分较低，经年龄校正后，血清 omentin-1 水平较低，RHI 值较低，体重值较高，身高值可比，HF% 和 LF/HF比率值。我们还报告了糖尿病足受试者的 RHI 值和 HRV 指数与副交感神经活动增加（RMSDD 和 HF%）的表达呈负相关，并且与 LF/HF 比值和交感迷走神经平衡的表达呈统计学显着正相关. 糖尿病足患者表现出较高程度的副交感神经系统激活，表现为 HF 值的增加和较低的 LF/HF 比值。我们的研究结果可能证实了一个问题，即副交感神经功能障碍可能在糖尿病足患者其他血管并发症的发病机制中具有附加作用。