Análise da modulação autonômica em repouso e em resposta ao Tilt Test ativo em crianças com diabetes tipo 1
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Data
2015-12-11
Autores
Giacon, Thais Roque [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A diabetes mellitus tipo 1 (DM1) tem sido o apontada como o distúrbio endócrino mais comum entre as crianças, apresentando como uma de suas complicações mais frequente a disfunção autonômica diabética, portanto é fundamental identificar e prevenir as alterações induzidas pela DM1 no sistema nervoso autônomo. Objetivos: 1) Estudar em crianças com DM1 a modulação autonômica, por meio dos índices da variabilidade da frequência cardíaca (VFC) obtidos pelos índices geométricos (RRtri, TINN e plot de Poincaré). 2) Analisar a resposta da modulação autonômica de crianças com DM1 induzidas pela realização do Tilt Test ativo e estudar nessas crianças a modulação autonômica, por meio de índices de VFC, considerando como ajuste sexo, idade, raça, porcentagem de gordura corporal e glicemia casual. Métodos: Foram analisados dados de crianças com idade entre 7 a 15 anos, as quais foram divididas em dois grupos, com diagnóstico de DM1 e sem a patologia. O protocolo experimental foi desenvolvido em duas etapas: na primeira foram coletados: peso, altura, percentual de gordura, frequência cardíaca, pressão arterial e glicemia casual. Na segunda etapa foi realizada a análise da modulação autonômica. Para isso foi captada a frequência cardíaca batimento a batimento das crianças por meio de um cardiofrequencímetro na posição supina por 30 minutos e após durante 10 minutos para a realização do Tilt Test ativo. Foram calculados os índices de VFC no domínio do tempo, os estatísticos e os geométricos, e no domínio da frequência. Para cumprir com o primeiro objetivo, utilizou-se para a análise dos dados o Teste t de Student para dados não pareados ou teste de Mann-Whitney dependendo da normalidade dos dados. Enquanto que, para atingir o segundo objetivo foi utilizada a Análise de Covariância para comparação entre grupos e Anova para comparar os efeitos do Tilt Test ativo, seguida de pós teste de Bonferroni. Esses dados foram ajustados por idade, sexo, raça, percentual de gordura e glicemia casual. Todos os testes foram realizados com nível de significância de 5%. Resultados: Crianças diabéticas apresentaram redução dos índices geométricos RRtri (12,35 vs 16,13), TINN (230 vs 325), SD1 (24,95 vs 36,4) e SD2 (76,22 vs 100,39). Na análise qualitativa do plot de Poincaré as crianças com DM1 apresentaram uma figura com menor dispersão dos intervalos RR. Além disso, as crianças com DM1 apresentaram redução de SDNN (50,4 vs 75,2), RMSSD (38,7 vs 57,6) e LFms² (693,6 vs 1874,6) e durante a realização do Tilt Test ativo as crianças de ambos os grupos apresentaram uma redução do SDNN, RMSSD e do LFms² em comparação com o repouso, sendo que essa resposta foi menos acentuada no grupo diabético. Conclusão: Conclui-se que crianças diabéticas apresentam alterações autonômicas caracterizadas por redução da variabilidade global e da atividade parassimpática. A realização do Tilt Test ativo mostrou que crianças de ambos os grupos apresentaram uma ativação simpática e uma redução da atividade parassimpática, sendo que esta resposta foi menos acentuada nas crianças diabéticas.
Introduction: The type 1 diabetes (T1D) has been identified as one of the most common diseases in childhood, which diabetic autonomic dysfunction is a frequent complication. Therefore is important to identify and prevent the autonomic complications induced by T1D. Objective: 1) Evaluate the autonomic modulation in children with T1D, using heart rate variability (HRV) obtained by geometric indexes (RRtri, TINN e Poincare plot). 2) Analyze the autonomic modulation response of children with T1D induced by active Tilt Test, by indexes of HRV, considering sex, age, ethnicity, body fat percentage and glycaemia casual. Methods: Two groups of children with age between 7 to 15 years old divided by diagnostic of T1D and without the disease were analyzed. The experimental protocol was developed in two steps: in the first one were evaluated the personal data, weight, height, body fat percentage, heart rate, blood pressure and glycaemia casual. In the second step was realized the analysis of autonomic modulation. The heart rate was obtained beat to beat through the heart rate monitor in supine position by 30 minutes and after during the active Tilt Test. The indexes of HRV were calculated in the time domain by statistics and geometric methods, and also in the frequency domain. The first objective was fulfilled using T Student Test analysis, or Mann-Whitney test for unpaired data. To achieve the second objective the Analysis of Covariance for comparison between groups and Anova for compare the effect of active Tilt Test, followed on posttest of Bonferroni were used. This data were adjusted for age, sex, ethnicity, body fat percentage and glycaemia casual. The statistical significance was set as 5% for all test. Results: The diabetic children were characterized by reduction of geometric indexes RRtri (12,35 vs 16,13), TINN (230 vs 325), SD1 (24,95 vs 36,4) and SD2 (76,22 vs 100,39). In the quantitative analysis of Poincare plot the children with T1D presented the figure with less dispersion of intervals RR. Furthermore, reduction of SDNN (50,4 vs 75,2), 22 RMSSD (38,7 vs 57,6) and LFms² (693,6 vs 1874,6) were also identified in children with T1D and during the active Tilt Test both groups of children presented reduction of SDNN, RMSSD and LFms² in comparison with the rest condition, and this response was smaller in the diabetic group. Conclusion: The diabetic children presented autonomic alteration characterized by reduction of global variability and parasympathetic activity. The active Tilt Test shown that children of both groups presented a sympathetic activation and a reduction of parasympathetic activity, and this response was smaller in diabetics children.
Introduction: The type 1 diabetes (T1D) has been identified as one of the most common diseases in childhood, which diabetic autonomic dysfunction is a frequent complication. Therefore is important to identify and prevent the autonomic complications induced by T1D. Objective: 1) Evaluate the autonomic modulation in children with T1D, using heart rate variability (HRV) obtained by geometric indexes (RRtri, TINN e Poincare plot). 2) Analyze the autonomic modulation response of children with T1D induced by active Tilt Test, by indexes of HRV, considering sex, age, ethnicity, body fat percentage and glycaemia casual. Methods: Two groups of children with age between 7 to 15 years old divided by diagnostic of T1D and without the disease were analyzed. The experimental protocol was developed in two steps: in the first one were evaluated the personal data, weight, height, body fat percentage, heart rate, blood pressure and glycaemia casual. In the second step was realized the analysis of autonomic modulation. The heart rate was obtained beat to beat through the heart rate monitor in supine position by 30 minutes and after during the active Tilt Test. The indexes of HRV were calculated in the time domain by statistics and geometric methods, and also in the frequency domain. The first objective was fulfilled using T Student Test analysis, or Mann-Whitney test for unpaired data. To achieve the second objective the Analysis of Covariance for comparison between groups and Anova for compare the effect of active Tilt Test, followed on posttest of Bonferroni were used. This data were adjusted for age, sex, ethnicity, body fat percentage and glycaemia casual. The statistical significance was set as 5% for all test. Results: The diabetic children were characterized by reduction of geometric indexes RRtri (12,35 vs 16,13), TINN (230 vs 325), SD1 (24,95 vs 36,4) and SD2 (76,22 vs 100,39). In the quantitative analysis of Poincare plot the children with T1D presented the figure with less dispersion of intervals RR. Furthermore, reduction of SDNN (50,4 vs 75,2), 22 RMSSD (38,7 vs 57,6) and LFms² (693,6 vs 1874,6) were also identified in children with T1D and during the active Tilt Test both groups of children presented reduction of SDNN, RMSSD and LFms² in comparison with the rest condition, and this response was smaller in the diabetic group. Conclusion: The diabetic children presented autonomic alteration characterized by reduction of global variability and parasympathetic activity. The active Tilt Test shown that children of both groups presented a sympathetic activation and a reduction of parasympathetic activity, and this response was smaller in diabetics children.
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Palavras-chave
Diabetes Mellitus, Sistema Nervoso, Crianças