不同静息心率的原发性高血压患者自主神经昼夜平衡变化规律  

Circadian changes of autonomic nervous system in essential hypertensive patients with different resting heart rate

作　　者：卢佳佳[1] 宋旷蓉[1] 李雪松[1] 张硕[1] 管颖[1] 赵良桥[1] 刘婷[1] 冷永群[1] 叶静[1] LU jia-jia;SONG Kuang-rong;LI Xue-song;ZHANG Shuo;GUAN Ying;ZHAO Liang-qiao;LIU Ting;LENG Yong- qun;YE Jing(Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院,武汉430022

出　　处：《内科急危重症杂志》2018年第3期220-222,238,共4页Journal of Critical Care In Internal Medicine

基　　金：武汉市卫计委项目(No:WX15B19)

摘　　要：目的:探讨不同静息心率(RHR)的原发性高血压(EH)患者自主神经昼夜平衡变化规律。方法:选取原发性高血压患者314例,比较不同静息心率原发性高血压患者昼夜交感指标极低频值(VLF)、低频值(LF)、迷走神经张力指标高频值(HF)以及LF/HF均值水平。采用单因素和多因素线性回归分析交感、迷走神经张力指标与昼夜静息心率的相关性。结果:与RHR-L同时间段相比,VLF、LF、HF值较低(P<0.05),LF/HF值较高(P<0.05)。与RHR-M同时间段相比,VLF、HF值较低(P<0.05),LF/HF值较高(P<0.05)。昼间静息心率与VLF、LF、HF均呈负相关(r=-0.321,r^2=0.103,r=-0.286,r^2=0.082,r=-0.437,r^2=0.191,均P<0.05);与LF/HF呈正相关(r=0.294,r^2=0.0864,均P<0.05)。夜间静息心率与VLF、LF、HF呈负相关(r=-0.345,r^2=0.119,r=-0.357,r^2=0.127,r=-0.445,r^2=0.198,均P<0.05);与LF/HF呈正相关(r=0.085,r^2=0.00723,P>0.05)。多元线性回归分析发现昼间VLF、HF、LF/HF是静息心率变化的影响因素(B=-0.001,P<0.01;B=-0.007,P<0.05;B=0.861,P<0.01);夜间VLF、LF、LF/HF是静息心率变化的影响因素(B=-0.001,B=-0.003,B=0.447,均P<0.05)。结论:交感神经张力和迷走神经张力的差值与昼夜静息心率呈正相关。昼间迷走神经张力占主要影响,而夜间交感神经张力起主要作用。Objective： To investigate the circadian changes of autonomic nervous system in essential hypertensive patients with different resting heart rate（ RHR）. Methods： 314 cases of essential hypertension were selected from Wuhan No. 1 Hospital Affiliated to Tongji Medical College from 2013. The clinical data of patients with essential hypertension were compared. Mean levels of circadian sympathetic and vagal tone were calculated in different RHR in patients with essential hypertension. Correlation between circadian sympathetic and vagal tone indexes and RHR was analyzed. Multivariate linear regression analysis was carried out in the circadian of sympathetic tone and vagal tone factors for RHR. Results： The VLF,LF and HF levels were lower（ P〈0. 05） and the LF/HF ratio was higher（ P〈0. 05） in the RHR-M and RHR-H groups than in the RHR-L group at the same time. The VLF and HF levels were lower（ P〈0. 05）,and the LF/HF level was higher（ P〈0. 05） in the RHR-H group than in the RHR-M group at the same time（ P〈0. 05）. However,RHR was negatively correlated to VLF,LF and HF（ r^2= 0. 103,P〈0. 05; r^2= 0. 082,P〈0. 05; r^2= 0. 191,P〈0. 05）,and positively correlated to LF/HF ratio（ r^2= 0. 0864,P〈0. 05） in the daytime. RHR was negatively correlated to VLF,LF and HF（ r^2= 0. 119,P〈0. 05; r^2= 0. 127,P〈0. 05; r^2= 0. 198,P〈0. 05）,and positively correlated to LF/HF ratio（ r^2= 0. 00723,P〉0. 05） in the nighttime. Multiple linear regression analysis indicated that the VLF,HF,and LF/HF ratio were the influencing factors of RHR changing（ B = 0. 001,P〈0. 01; B = 0. 007,P〈0. 05; B = 0. 861,P〈0. 01） in the daytime. VLF,LF and LF/HF ratio were the influencing factors of RHR regulation（ B = 0. 001,P〈0. 05; B = 0. 003,P〈0. 05; B =0. 447,P〈0. 05）. Conclusion： The difference of sympathetic tone and vagal tone was positively correlated with the RHR in the daytime and nighttime. The main effect of vagal tone for daytime RHR and sympathetic nerve tension play

关 键 词：静息心率 原发性高血压 自主神经系统 昼夜动态平衡 

分 类 号：R544.11[医药卫生—心血管疾病]