冠心病患者心率变异性与心脏变时功能不全的关系  

Relation of heart rate variability and chronotropic incompetence in patient with coronary herat disease

作　　者：冯应君[1] 杨汉东[1] 闵新文[1] 陈欣[1] 李东峰[1] 许浩[1] 

机构地区：[1]郧阳医学院附属东风医院心内科,湖北十堰442008

出　　处：《临床心血管病杂志》2007年第12期919-921,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨冠心病患者心率变异性与心脏变时功能不全的关系。方法:选择经冠状动脉造影确诊的91例冠心病患者,冠状动脉造影前1个月内完成24h动态心电图检查并求心率变异时域指标,完成症状限制性踏车运动试验并求心脏变时功能指标最高心率与预测最大心率值之比(rHR)和心率储备率(HRR)。结果:变时功能不全患者各项心率变异指标显著低于变时功能正常者(P<0.01)。所有病例的心率变异指标SDNN、SDANN、SDNNindex、rMssD及PNN50与rHR(依次r=0.548、0.453、0.325、0.340、0.211)和HRR(依次r=0.580、0.477、0.363、0.338、0.190)均存在明显正相关(均P<0.01)。结论:冠心病患者心脏变时功能不全与心脏自主神经功能失常密切相关,其可能的机制与运动中迷走神经活性抑制不全和交感神经活性增强受限有关。Objective:To explore the role of autonomic nerve function on chronotropic incompetence(CI)in patients with coronary atherosclerotic herat diseas(CHD).Method:Ninty-one patients were diagnosised coronary atherosclerotic herat disease by coronary angiography.In a month before coronary angiography,24 hours dynamic electrocardiogram had been accomplished for every patient and time domain indexes of heart rate variability(HRV)had been measured.Meanwhile,symptom-limited exercise treadmill tests had been executed,the chronotropic response had been measured and expressed as ratio of heart rate reserve(HRR)and the percent maximal age-predicted heart rate achieved(rHR).All patients were divided to two groups:the normal chronotropic response group(with rHR≥85% or HRR≥72%)and the chronotropic incompetence group(with rHR<85% or HRR<72%),and test was used to compare HRV difference between two groups.The pearson correlation analysis was used to analysis the correlation between HRV and CI.Result:In chronotropic incompetence patients,all heart rate variability indexes were lower than that in the patients with normal chronotropic response(P<0.01).There were significantly positive correlation between heart rate variability indexes SDNN,SDANN,SDNNindex、 rMSSD、PNN50 and rHR(r=0.548,0.453,0.325,0.340,0.211,respectively.all P<0.01),HRR(r=0.580,0.477,0.363,0.338,0.190,respectively.all P<0.01).Conclusion:There were very intimate correlation between chronotropic incompetence and cardiac dysautonomia in CHD patients,and possible mechanisms would be that vagal activity could not been inhibited sufficiently and sympathetic activity could not been augmentated equately in exercise tests.

关 键 词：冠状动脉疾病 心室功能障碍 心率变异 

分 类 号：R541.4[医药卫生—心血管疾病]