老年原发性高血压合并2型糖尿病患者心率震荡的变化及其临床意义  

Changes and clinical significance of heart rate turbulence in elderly patients with essential hypertension accompanied by type 2 diabetes mellitus

作　　者：蒲春伶[1] 李法琦[1] 王偕莲[1] 邓国兰[2] 吕波[2] 

机构地区：[1]重庆医科大学附属第一医院老年病科,重庆400016 [2]重庆医科大学附属第一医院心内科Holter室

出　　处：《中国老年学杂志》2011年第5期759-761,共3页Chinese Journal of Gerontology

摘　　要：目的探讨老年原发性高血压(EH)合并2型糖尿病(T2DM)患者心率震荡(HRT)的变化规律和临床意义。方法收集资料齐全的门诊及住院老年EH合并T2DM患者133例(EH+T2DM组)、单纯老年EH患者140例(EH组)、单纯老年T2DM患者130例(T2DM组)、老年健康体检者141例(老年对照组)和年轻健康体检者139例(年轻对照组)均接受24 h动态心电图记录,利用美国的Space Lab分析系统自动回放扫描并计算出反映HRT的各项指标:震荡初始(TO)、震荡斜率(TS)、震荡斜率起始时间(TT)和动态心率震荡(TD),比较各组之间HRT各项指标的差异,并分析TO、TS、TT、TD与年龄、平均心率、心率变异性(HRV)时域指标(SDNN)之间的关系。结果老年对照组TO和TT均明显高于年轻对照组(均P<0.01),但TS、TD和SDNN均明显低于年轻对照组(均P<0.05);EH+T2DM组TO均明显高于但TS、TD和SDNN均明显低于EH组和T2DM组(均P<0.05),EH+T2DM组TO均显著高于但TS、TD和SDNN均显著低于老年对照组(均P<0.01),EH组和T2DM组TO均明显高于但TS、TD和SDNN均明显低于老年对照组(均P<0.05),EH组与T2DM组间TO、TS、TD和SDNN均无显著差异(均P>0.05),老年各组间TT均无显著差异(均P>0.05)。TO与年龄呈正相关(P<0.01),与TS、TD和SDNN均呈负相关(均P<0.05);TS与TD和SDNN均呈正相关(均P<0.01);TD与平均心率和TO均呈负相关(均P<0.05)而与TS和SDNN均呈正相关(均P<0.01)。结论老年EH合并T2DM患者较老年EH患者、老年T2DM患者和老年健康体检者及老年EH和老年T2DM患者较老年健康体检者HRT均明显减弱,其自主神经功能明显受损且以老年EH合并T2DM患者自主神经功能受损最严重。Objective To investigate the variations and clinical significance of heart rate turbulence（HRT） parameters in elderly patients with essential hypertension（EH） combined with type 2 diabetes mellitus（T2DM）.Methods The turbulence onset（T0）,turbulence slope（TS）,turbulence timing（TT）,turbulence dynamics（TD） and standard deviation of the NN interval（SDNN） were measured in 133 elderly patients with EH combined with T2DM（EH＋T2DM group）,141 elderly patients with EH only（EH group）,130 elderly patients with T2DM only（T2DM group）,140 senile healthy controls（senile control group） and 139 youth healthy controls（young control group） by the Space Lab software using 24 hour dynamic electrocardiogram（Holter） records.Correlations of T0,TS,TT and TD with age,mean heart rate,SDNN were analyzed.Results Compared with young control group,TO and TT were increased（all P0.01）,but TS,TD and SDNN decreased significantly in senile control group（all P0.05）.Compared with EH group and T2DM group,TO was enhanced but TS,TD and SDNN reduced obviously in EH＋T2DM group（all P0.05）.Compared with senile control group,TO was increased but TS,TD and SDNN decreased obviously in EH＋T2DM group（all P0.01）.Compared with senile control group,TO was raised up but TS,TD and SDNN cut down obviously in EH group and T2DM group（all P0.05）.TO,TS,TD and SDNN had no change between EH group and T2DM group（all P0.05）.TT had no alteration among 4 groups of the old people（all P0.05）.Conclusions HRT is significantly attenuated in old patients with EH and T2DM only or EH accompanied by T2DM,suggesting the autonomic nerve function of elderly patients with EH and T2DM only or EH accompanied by T2DM be severely damaged but the impairment of autonomic nerve function in elderly patients with EH accompanied by T2DM be the best noticeable.

关 键 词：高血压 糖尿病 心率震荡 心率变异 老年人 

分 类 号：R544.1[医药卫生—心血管疾病]