扩张型心肌病患者心率加速力和减速力变化的临床意义  

Clinical significance of heart rate acceleration capacity and deceleration capacity in patients with dilated cardiomyopathy

作　　者：董宏凯 邹操[1] 王枫艳 高美雯[2] 黄杏梅[2] 金建玲[2] 张宇祯[1] 杨向军[1] 

机构地区：[1]苏州大学附属第一医院心内科,武汉215006 [2]苏州大学附属第一医院心电图室

出　　处：《临床心血管病杂志》2015年第7期769-772,共4页Journal of Clinical Cardiology

基　　金：江苏省"六大人才高峰"第十批高层次人才培养计划资助项目(No:WSN-067);江苏省自然科学基金(No:BK20140293)

摘　　要：目的:探讨扩张型心肌病(DCM)患者心率加速力(AC)和减速力(DC)变化的临床意义。方法:选择43例DCM患者(DCM组)和41例无器质性心脏病患者(对照组)行心脏超声心动图和24h动态心电图检查,比较两组间AC值、DC值及心率变异性(HRV)指标的差别;DCM患者按DC值分为低、中、高危3组,比较3组间AC值、DC值、左房内径(LAd)、左室舒张末径(LVEDd)和左室射血分数(LVEF)的差别,并分析上述指标间的相关性。结果:与对照组相比,DCM组患者AC值增加[(-8.30±1.88)ms︰(-5.10±2.47)ms,P<0.01]、DC值降低[(7.90±1.94)ms︰(4.00±2.00)ms,P<0.01],HRV指标SDNN、LF和vLF均降低(均P<0.05)。与低危组相比,DCM中危组AC值增加[(-6.80±1.81)ms︰(-3.90±0.90)ms,P<0.01]、DC值降低[(6.40±1.56)ms︰(3.70±0.50)ms,P<0.01),但高危组AC值[(-5.80±4.32)ms]和DC值[(1.30±0.96)ms]较中危组均降低(P<0.01);DCM低、中、高危3组间LAd差别有统计学意义[(45.30±7.42)mm、(51.90±6.95)mm、(54.90±11.14)mm,P<0.01]。DCM患者AC值与LAd(r=0.473,P<0.01)、LVEDd(r=0.441,P<0.01)呈正相关,与LVEF呈负相关(r=-0.569,P<0.01);DC值与LAd(r=-0.505,P<0.01)、LVEDd(r=-0.421,P<0.01)呈负相关,与LVEF呈正相关(r=0.632,P<0.01)。结论:AC和DC评价自主神经功能优于HRV指标;DCM患者自主神经功能受损,与心脏本身病变进展相关。Objective：To investigate the clinical significance of changes of heart rate acceleration capacity（AC）and deceleration capacity（DC）in patients with dilated cardiomyopathy（DCM）.Method：AC,DC,heart rate variability,left atrial diameter（LAd）,left ventricular end diastolic diameter（LVEDd）and left ventricular ejection fraction（LVEF）were detected in 43 cases of DCM patients（DCM group）and 41 patients without organic heart disease（control group）by using 24 hdynamic electrocardiogram and echocardiography.According to the DC value,patients with DCM were divided into three groups：low risk group,median risk group and high risk group.Result：Compared to control group,AC values[（-8.30±1.88）ms︰（-5.10±2.47）ms,P〈0.01]in DCM group were increased while DC values[（7.90±1.94）ms︰（4.00±2.00）ms,P〈0.01]and HRV index including SDNN,LF and vLF were decreased（all P〈0.05）.Compared to low risk patients in DCM group,AC values increased[（-6.80±1.81）ms︰（-3.90±0.90）ms,P〈0.01）and DC values decreased [（6.40±1.56）ms︰（3.70±0.50）ms,P〈0.01]in median risk patients,but both AC [（-5.80±4.32）ms]and DC values[（1.30±0.96）ms]were decreased in high risk patients compared with median risk patients（all P〈0.01）.There were significant differences of LAd between low,median and high risk patients[（45.30±7.42）mm ︰（51.90±6.95）mm∶（54.90±11.140）mm,P〈0.01].There were significant positive correlations between AC value and the LAd（r=0.473,P〈0.01）and LVEDd（r=0.441,P〈0.01）respectively as well as negative correlation with LVEF（r=-0.569,P〈0.01）;and there were significant negative correlations between DC value and LAd（r=-0.505,P〈0.01）and LVEDd（r=-0.421,P〈0.01）respectively as well as positive correlation with LVEF（r=0.632,P〈0.01）.Conclusion：AC and DC value are better than HRV for evaluation of autonomic nerve function;autonomic nervous function in DCM patients is impaired due to progressive cardiac disease

关 键 词：扩张型心肌病 心率加速力 心率减速力 心率变异性 自主神经 

分 类 号：R542.1[医药卫生—心血管疾病]