冠心病患者窦性心率震荡及心率变异性的变化  

Changes of heart rate turbulence and heart rate variability in patients with coronary heart cisease

作　　者：戴朝晖[1] 刘启明[2] 周胜华[2] 祁述善[2] 欧阳定安[1] 

机构地区：[1]长沙市第四医院心内二科,长沙410006 [2]中南大学湘雅二医院心内科

出　　处：《中国医师杂志》2010年第7期899-902,共4页Journal of Chinese Physician

摘　　要：目的 对冠心病患者窦性心率震荡（HRT）及心率变异性（HRV）指标进行分析,评价冠心病、冠脉病变与HRT、HRV的关系,以及两种指标的相关性.方法 选择经冠状动脉造影证实的冠心病患者103例（A组）,其中稳定性心绞痛（SAP）患者35例（A1组）、不稳定性心绞痛（UAP）患者28例（A2组）、急性心肌梗死（AMI）患者40例（A3组）与有室性期前收缩但无器质性心脏病患者30例为健康对照组（B组）,行常规24 h动态心电图检查,测定HRT指标（震荡起始TO及震荡斜率TS）及HRV各时域指标（SDNN、PNN50、HF）.结果 （1）A组各亚组TO值明显高于B组（-4.17±2.75、-3.16±3.18、-0.96±2.92;-6.30±3.47）,TS值明显低于B组（6.81±3.18、5.12±3.31、3.20±1.71;9.52±3.85）（P＜0.05 or P＜0.01）;A组各亚组HRV各时域指标（SDNN、PNN50、HF）值均明显低于B组（P＜0.05）;（2）在A1组中,TO与冠脉评分呈正相关;TS、SDNN、PNN50、HF与冠脉评分呈负相关,其中与TS相关性最强（r=0.45）;（3）TO与SDNN、PNN50、HF均呈负相关;TS与SDNN、PNN50、HF均呈正相关,其中与HF的相关性相对较强（r=0.47）.结论 （1）冠心病患者HRT现象变钝（TO值升高,TS值降低）,HRV各时域指标降低;（2）在预测冠脉病变严重程度上,HRT参数特别是TS相对HRV指标能更敏感地反映冠脉严重程度;（3）HRT与HRV参数间有相关性,其中TS与HF相关性较强.Objective To analyze the changes of heart rate turbulence （HRT） and heart rate variability （HRV） in coronary heart disease （CHD）, and evaluate the relationship between CHD and coronary artery disease （CAD） and two parameters of HRT and HRV, and investigate the correlation between the 2 parameters.Methods We performed coronary angiography in all 103 patients with CHD （group A）, who were classified into 3 subgroups： 35 patients of stable angina pectoris （ group A1 ）, 28 patients of unstable angina pectoris （ group A2 ） and 40 patients of AMI （ group A3 ）, and 30 structurally normal patients with ventricular premature contraction who were included in healthy control group （ group B）.The 24-hour ambulatory electrocardiogram was performed in all the patients, and the parameters of HRT and HRV were obtained.Results The value of the TO onset of group A was significantly higher than that of group B（ -4.17± 2.75, - 3.16 ± 3.18, - 0.96 ± 2.92; - 6.30 ± 3.47 ）, the value of TS of group A was lower than that of groupB（6.81±3.18,5.12±3.31,3.20±1.71;9.52±3.85） （P ＜0.05 orP ＜0.01）.The values of SDNN, PNN50, and HF of group A were significantly lower than those of group B （P＜ 0.05）.TO was positively correlated with Gensinies score, while TS, SDNN, PNN50 and HF were negatively correlated with Gensinies score, and TS showed the strongest negative correlation with Gensini score （r=-0.45）.TO was negatively correlated with SDNN, PNN50, and HF, while TS was positively correlated with SDNN, PNN50 and HF, and TS showed much stronger correlation with HF （r=0.47）.Conclusions HRT was dramatically blunted and HRV in patients with CHD was significantly lower;.HRT and HRV of group A1 were significantly correlated with Gensini score, and TS had the strongest correlation with Gensini score.TO and TS were correlated with SDNN, PNN50 and HF, and TS had much stronger relationship with HF.

关 键 词：冠心病/病理生理学 心率 

分 类 号：R541.4[医药卫生—心血管疾病]