癌症患者456例心率变异性与预后的关系探讨  

Prognostic value of heart rate variability in patients with cancer

作　　者：陶卉[1] 于杨[1] 刘筱[1] 吴群英 TAO Hui;YU Yang;LIU Xiao;WU Qun-ying(Department of Cardiac Function,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院心功能科,湖北武汉430014

出　　处：《广东医学》2020年第5期478-481,共4页Guangdong Medical Journal

摘　　要：目的研究癌症患者的心率变异性(HRV),探讨癌症患者自主神经功能状况,分析其HRV与生存预后的相关性。方法回顾性分析在医院行24 h动态心电图(Holter)监测的456例癌症患者的完整资料。记录癌症患者HRV的指标[全部NN间期的标准差(SDNN)],并分为SDNN≥70 ms患者组(Ⅰ组,n=364)及SDNN<70 ms患者组(Ⅱ组,n=92)。应用单因素生存曲线及多因素Cox回归进行两组间的比较。结果(1)Ⅱ组患者多见于男性(P=0.013);且多为血液恶性肿瘤(P=0.031),并有服用5-羟色胺再摄取抑制药(SSRIs)治疗(P=0.013),差异有统计学意义;(2)单因素生存曲线显示Ⅰ组患者的存活率明显高于Ⅱ组患者(Ⅰ组79.6周vsⅡ组21.3周,P<0.0001);(3)多因素Cox回归分析显示,SDNN<70 ms对癌症患者的生存具有重要意义(HR:1.7,95%CI:1.3~2.8),且年龄、肿瘤阶段及不良体能状态是其独立危险因素。结论癌症患者HRV的降低与存活率较短有关。Objective To investigate the heart rate variability(HRV)in patients with cancer,and examined the association between HRV,which reflecting the autonomic function,and survival in a large cohort of patients with cancer.Methods We retrospectively examined the records of 456 patients with cancer,who had undergone ambulatory electrocardiogram monitoring for 24 hours,from May 2013 to October 2017 in the Central Hospital of Wuhan.Time domain HRV was calculated.Survival were compared between patients with SDNN≥70 milliseconds(Group 1,n=364)and those with SDNN<70 milliseconds(Group 2,n=92)by Kaplan-Meier method and multivariate Cox regression analysis.Results Patients in Group 2 had a significantly higher percentages of male patients(P=0.013),hematological malignancies(P=0.031),and usage of serotonin reuptake inhibitor antidepressants(P=0.013).Patients in Group 2 had a significantly shorter survival rate(25%of patients in Group 2 died by 21.3 weeks vs.79.6 weeks in Group,P<0.0001).Multivariate analysis showed that SDNN<70 milliseconds remained significant for survival(HR:1.7;95%CI:1.3-2.8).Conclusion The presence of cancer in combination with decreased heart rate variability(SDNN<70 milliseconds)is associated with shorter survival time.

关 键 词：心率变异性 癌症 生存 

分 类 号：R446.1[医药卫生—诊断学] R73[医药卫生—临床医学]