经皮冠状动脉介入术后伴发抑郁焦虑状态患者的心率变异性分析  

Heart rate variability of patients with depression and anxiety after percutaneous coronary intervention

作　　者：胡司淦[1] 王一波 骆祥芬[3] 徐玮[1] 谢彩侠[1] 朱建[1] 李辉[1] 曲孝龙[1] 陈天平[1] 高大胜[1] 张恒[1] 王洪巨[1] 

机构地区：[1]蚌埠医学院第一附属医院,安徽蚌埠233004 [2]上海黄浦区中心医院 [3]安徽省荣军医院

出　　处：《中国心脏起搏与心电生理杂志》2017年第3期242-246,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：安徽高校研究重点项目(NO.SK2016A0595);蚌埠市科技局课题(NO.20150336);2015年安徽省教育厅重大项目(NO.KJ2015ZD30)

摘　　要：目的本研究通过观察冠心病经皮冠状动脉介入术(PCI)后伴发抑郁焦虑患者的心率变异性(HRV)变化,探讨HRV与PCI术后伴发抑郁焦虑的相关性和对自主神经功能紊乱的预测价值。方法 85例PCI术后1个月患者,完成PHQ-9和GAD-7量表后进行HRV检测。根据PHQ-9及GAD-7量表评分为四组,A组为PHQ-9评分>13分,且GAD-7评分≤10分;B组为GAD-7评分>10分,且PHQ-9评分≤13分;C组为PHQ-9>13分,且GAD-7评分>10分;D组为PHQ-9≤13分,且GAD-7评分≤10分。分别观察组间的HRV变化及相关性。结果基础心率在A、B、C三组均高于D组(P<0.01或0.05);正常RR间期标准差(SDNN)、正常RR间期平均值标准差(SDANN)、相邻正常RR间期差值均方的平方根(RMSSD)、相邻正常RR间期差值大于50 ms的计数占总RR间期计数的百分比(pNN50)、正常RR间期标准差平均值指标D组明显高于A、B、C组(P均<0.01);SDNN、SDANN、RMSSD指标C组明显低于B组(P<0.01或0.05)。极低频功率(VLF)、低频功率(LF)、LF/HF比值A、B、D三组明显低于C组(P<0.01或0.05);LF、LF/HF比值A、B组明显高于D组(P均<0.01);HF指标D组明显高于C组(P均<0.01)。结论冠心病PCI术后患者伴发抑郁焦虑状态患者存在明显的HRV下降,LF/HF比值可以作为这类患者的神经生物学观察指标,对PCI术后出现抑郁与焦虑情绪有一定的预测价值。Objective This study evaluate the heart rate variability （HRV） of patients with depression and anxiety after pereutaneous coronary intervention （PCI） and the correlation between depression anxiety and heart rate varia bility （HRV） to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder. Methods A total of 85 patients received PCI 1 month ago were selected as subjects, and their HRV was measured after they completed the PHQ9 scale and the GAD-7 scale. They were divided into four groups, according to the PHQ-9 and GAff〉7 score. Group A was PHQ9 score 〉13, and the GAD-7 score was≤10. Group B was the GAD-7 score〉10, and PHQ-9 score≤13. Group C was the PHQ 9 score 〉13,and GAff〉7score〉10. Group D was the PHQ-9 score≤13, and GAD-7 score≤10. The change of HRV and correlation between the four groups were observed. Results The heart rate of group A, B and C were higher than that of groupD（P〈0.01 or 0.05）. The standard deviation of RR intervals（SDNN）, standard deviation of the average RR intervals for all of the five minute intervals （SDANN）, root mean square of different from the prior interval（RMSSD） ,percent RR intervals〉？50 ms different from the prior interval（pNN50）, SDNN index of group D were higher than that of group A, B and C（P〈0.01 or P〈0.05）.SDNN, SDANN, RMSSD of group C were lower than that of group B（P〈0.01 or P〈0.05）. Very low frequency power（VLF）, low frequency power（LF）,LF/HF of group A, B and D were lower than that of group C（P〈0.01 or 0.05）. LF, LF/HF of group A, B were higher than that of group D（P〈0.01）. HF of group D was higher than that of group C（P〈0.01）. Conclusions The de- crease of HRV are observed among coronary heart disease received PCI.The LF/HF ratio, a standard index of auto- nomic nervous system activity, can be used as an objective neurobiological index to analyze depression and anxiety a- mong these patients and can act as a

关 键 词：心血管病学 冠心病 心率变异性 抑郁 焦虑 经皮冠状动脉介入术 

分 类 号：R541.4[医药卫生—心血管疾病] R749.72[医药卫生—内科学]