老年代谢综合征患者血清同型半胱氨酸与心率变异的相关性研究  

Relationship between serum homocysteine levels and heart rate variability in elderly patients with metabolic syndrome

作　　者：杨茜岚[1] 陈炜钢[2] 鲁翔[1] 胡维维[1] 何慧薇[1] 

机构地区：[1]南京医科大学第二附属医院老年科,210011 [2]南京医科大学第二附属医院检验科,210011

出　　处：《中华老年医学杂志》2017年第6期632-635,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨老年代谢综合征患者血清同型半胱氨酸（Hcy）与心率变异（HRV）的关系。方法回顾性分析，选取2013年1月至2016年8月在我院就诊的60岁及以上老年代谢综合征患者162例进行病例对照研究，并根据Hcy水平分为3组，正常组（Hcy值5～15μmol／L）42例，轻度升高组（Hey值16～30μmol／L）70例，中度升高组（Hcy值31～100／μmol／L）50例。人选者检测血清Hcy平及其他生化指标，同时采用24h动态心率变异性频谱分析技术测定HRV，对血Hcy水平与HRV作相关性分析。结果Hcy轻度升高组与Hcy中度升高组的正常RR间期的标准差（SDNN）、5min平均心率的标准差（sDANN）、爱丁堡指数（PNN50）、相邻RR间期之差的均方根值（RMMSD）均低于Hcy正常组（P〈0．05）。Hcy轻度升高组与Hcy中度升高组的低频（LF）、高频（HF）均低于Hcy正常组（P〈0．05），Hcy轻度升高组与Hcy中度升高组的夜间交感迷走神经平衡指标（LF／HF）均高于Hcy正常组（P〈0．05）。Hcy升高组较Hcy正常组HRV指数下降，Hcy与SDANN、RMSSD、LF、HF、夜间LF／HF呈负相关（r值分别为-0．578、-0．651、-0．531、-0．662、-0．729，均P〈0.01）。结论老年代谢综合征合并高Hcy血症患者HRV减低，提示心脏自主神经功能调节损伤；临床上加强对老年代谢综合征合并高Hcy血症患者HRV检测，有助于早期发现自主神经病变。Objective To investigate the relationship between the serum homocysteine（Hcy） level and heart rate variability in elderly patients with metabolic syndrome. Methods Retrospective analysis of 162 elderly patients with metabolic syndrome aged 60 and above was conducted in our hospital from January 2013 to August 2016. And the level of serum homocysteine and other biochemical indicators were measured. The 162 cases were divided into three groups of 42 cases in Hcy normal group（Hcy,5 15μmol/L） ,70 cases in Hcy mildly high group（Hcy,16-30 μmol/L） ,50 cases in Hcy moderately high group（ Hcy, 31 100 μmol/L）. Simultaneously 24-hour rhythm in ambulatory heart rate variability spectrum was used to detect HRV. And the relationship between heart rate variability（HRV） and Hcy levels were analyzed. Results Normal RR interval standand deviation （SDNN） ,5 min mean heart rate standard deviation（SDANN）, Edinburg index（PNN50）, root mean square value of adjacent RR interval difference（RMMSD）were all lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group （P 〈0.05 ）. Low-frequency （LF） and high frequency（HF） were lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group（P〈0.05）. Sympathetic-vagal balance indicators （LF/HF）were higher in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group（P〈0.05）. The HRV indexes were lower in Hcy high groups than in the Hcy normal group. Hcy was negatively correlated with SDANN,RMSSD,LF, HF, and LF/HF at night（r= - 0. 578, - 0. 651, - 0. 531, - 0. 662, - 0. 729, all P 〈0.01 ） . Conclusions The elevated homocysteine level and metabolic syndromecombined with decreased HRV in the elderly patients suggest that cardiac autonomic nervous system might be injuried. Enhancing the detection of HRV and homocysteine level in elderly patientswith MS is clinically useful for early detection of autonomic neuropathy.

关 键 词：代谢综合征 高半胱氨酸 心率 

分 类 号：R589[医药卫生—内分泌]