慢性肾脏病患者心率变异性的特点及其影响因素分析  

Characters of heart rate variability in patients with chronic kidney disease and its related factors

作　　者：王昱[1] 陈凯[1] 张继红[2] 鲍晓荣[1] WANY Yu CHEN Kai ZHANG Ji-hong BAO Xiao- rong(Department of Nephrology Central Laboratory, Jinshan Hospital, Fudan University, Shanghai 201508, China)

机构地区：[1]复旦大学附属金山医院肾内科,上海201508 [2]复旦大学附属金山医院中心实验室,上海201508

出　　处：《复旦学报（医学版）》2017年第1期47-52,共6页Fudan University Journal of Medical Sciences

基　　金：复旦大学附属金山医院优秀青年人才项目;上海市金山区卫计委青年项目(JSKJ-KTQN-2015-08)~~

摘　　要：目的探讨慢性肾脏病(chronic kidney disease,CKD)患者心率变异性(heart rate variability,HRV)的特点及影响因素。方法根据e GFR水平将250例透析前的CKD患者分成CKD1~5期组,所有患者行HRV检测(SDNN、SDNNI、RMSSD、PNN50),分析各期CKD患者HRV特点,并检测尿液指标尿白蛋白、尿肌酐等及血清学指标血常规、肾功能、糖代谢指标、血脂、电解质、C反应蛋白(C-reactive protein,CRP)、同型半胱氨酸(homocysteine,Hcy)、甲状旁腺素(parathyroid hormone,PTH)等,探讨HRV的影响因素。结果 CKD1~5期患者中HRV降低的比例分别为14.29%、54.90%、73.68%、80.43%和94.44%,除CKD3期和4期两组间比较差异无统计学意义(P>0.05),其余各组间比较差异均有统计学意义(P<0.05)。SDNN、SDNNI、RMSSD、PNN50在CKD1~5期患者间均呈逐渐减小趋势,与肾功能水平、血脂、血糖、PTH、Hcy、CRP、贫血、电解质、尿白尿白排泄率等指标呈显著相关。结论 CKD患者普遍存在HRV降低,且随着肾功能恶化不断加重。CKD患者HRV降低与其肾功能水平、脂代谢紊乱、糖代谢异常、贫血、继发性甲状旁腺功能亢进、微炎性状态、高Hcy血症、电解质异常及尿白蛋白排泄率增高等因素有关。Objective To claim the characters of heart rate variability（ HRV） of chronic kidney disease（ CKD） patients in different stage of renal function,and to explore its related factors. Methods All 250 CKD patients recruited in this study were divided into 5 groups（ CKD 1- 5 stage） according to the level of GFR. The HRV（ SDNN,SDNNI,RMSSD and PNN50） was analyzed among 5 groups. Some clinical characters such as urinary albumin,hemoglobin,hematocrit,serum urea,serum creatinine,serum uric acid,serum glucose, lipid, electrolytes, C-reactive protein（ CRP）, homocysteine（ Hcy）,parathyroid hormone（ PTH）, were decteced and investigated to elucidate their effects on HRV.Results The rates of declined HRV in CKD 1- 5 patients were 14. 29%,54. 90%,73. 68%,80. 43% and94. 44%,respectively. Significant differences（ P〈0. 05） could be found between every two groups,except CKD 3 and CKD 4. All parameters of HRV,SDNN,SDNNI,RMSSD,PNN50 showed a gradu ally decreasing trend from CKD1 to CKD5. They were significantly correlated with several clinical characters,such as renal function,hemoglobin,serum lipid,serum glucose,PTH,Hcy,CRP,electrolytes and urinary albumin excretion rate. Conclusions HRV was prevalence in CKD patients,and it was decreased together with the development of CKD. Renal function, hemoglobin, lipid, serum glucose, secondary hyerthyrosis,hyperthomocysteiemia,micro-inflammatory,electrolytes and urinary albumin excretion rate were related with the decline of HRV in CKD patients.

关 键 词：慢性肾脏病 心率变异性 影响因素 

分 类 号：R692.9[医药卫生—泌尿科学]