全部窦性心搏RR间期标准差对伴缺血的非阻塞性冠状动脉疾病患者冠状动脉微循环功能障碍的预测价值  

The Value of Standard Deviation of Normal RR Interval in Predicting Coronary Microvascular Dysfunction in Patients With Ischemia With Non Obstructive Coronary Arteries

作　　者：周宙 刘杨[1] 王震[1] 王咏[1] 张娟[1] 杨传华[1] ZHOU Zhou;LIU Yang;WANG Zhen;WANG Yong;ZHANG Juan;YANG Chuanhua(Department of Cardiology,Shandong University of Traditional Chinese Medicine,Affiliated Hospital of Shandong University of traditional Chinese Medicine,Jinan(250000),Shandong,China)

机构地区：[1]山东中医药大学山东中医药大学附属医院心内科,山东省济南市250000

出　　处：《中国循环杂志》2022年第8期804-809,共6页Chinese Circulation Journal

基　　金：国家自然科学基金(81573916,81804061);国家中医临床研究基地业务建设科研专项(JDZX2015141);山东省泰山学者建设工程专项基金(2018-35);山东省自然科学基金(ZR2020MR333);山东省中医药科技发展计划(2015-088)。

摘　　要：目的:分析全部窦性心搏RR间期标准差(SDNN)预测伴缺血的非阻塞性冠状动脉疾病(INOCA)患者存在冠状动脉微循环功能障碍(CMVD)的价值。方法:选择2018年6月至2021年6月在山东中医药大学附属医院接受微循环阻力指数(IMR)测定和24小时动态心电图检查的伴有缺血的INOCA患者81例。CMVD定义为IMR≥25。据此患者分为非CMVD组(n=40)和CMVD组(n=41)。Pearson相关分析评估正常RR间期的标准差(SDNN)、低频与高频比值(LF/HF)与IMR的之间的关系;采用Logistic回归分析评估CMVD的独立预测因素,采用ROC曲线分别评估SDNN、LF/HF、SDNN联合LF/HF对CMVD的预测价值。结果:CMVD患者占51%(41/81)。CMVD组中女性患者较多,且吸烟、高血压、糖尿病和有缺血性心脏病家族史的患者比例显著高于非CMVD组(P均<0.05)。CMVD组SDNN低于非CMVD组[(101.15±24.53)mm vs.(133.78±29.68)mm,P<0.01],而LF/HF(2.52±1.22 vs.2.00±0.93,P=0.03)较高。Logistic回归分析显示,女性(OR=8.5,P=0.002)、吸烟(OR=7.5,P=0.007)以及SDNN<100 ms(OR=4.6,P=0.018)均是CMVD的独立预测因素。此外,SDNN=99.5 ms能够较为可靠地预测INOCA患者的CMVD(灵敏度为82.9%,特异度为77.5%)。结论:SDNN<100 ms是INOCA患者存在CMVD的独立预测因素,而CMVD是引起INOCA的主要原因之一,我们认为自主神经系统在INOCA患者的微循环功能障碍中发挥重要作用。Objectives:Autonomic nervous system disorders and coronary microvascular dysfunction(CMVD)are risk factors for adverse cardiovascular events,especially in patients with ischemia with non obstructive coronary arteries(INOCA).The aim of this study was to evaluate the relationship between heart rate variability and microcirculatory function in INOCA patients.Methods:A total of 81 INOCA patients who underwent index of microcirculation resistance(IMR)measurement and 24 h electrocardiogram in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from June 2018 to June 2021 were included in this study.CMVD was defined as IMR≥25.The patients were divided into non-CMVD group(n=40)and CMVD group(n=41).Pearson correlation coefficients were calculated to evaluate the relationship between standard deviation of normal R-R intervals(SDNN)and IMR,and ratio of low frequency to high frequency(LF/HF)and IMR.Multivariate logistic regression analysis was used to evaluate the independent predictors of CMVD.The predictive value of SDNN,LF/HF and SDNN combined with LF/HF for CMVD was evaluated by ROC curve.Results:CMVD patients accounted for 51%of the total cohort.The results showed that there were more female patients in CMVD group,and the history of smoking,hypertension,diabetes and family history of ischemic heart disease were significantly more prevalent in CMVD group than in non-CMVD group.SDNN([101.15±24.53]ms vs.[133.78±29.68]ms,P<0.01)was significantly lower,while LF/HF(2.52±1.22 vs.2.00±0.93,P=0.03)was significantly higher in CMVD group than in non-CMVD group.Multivariate logistic regression analysis showed that female(OR=8.5,P=0.002),smoking history(OR=7.5,P=0.007),and SDNN<100 ms(OR=4.6,P=0.018)were independent predictors of CMVD.In addition,SDNN=99.5 ms could reliably predict the presence of CMVD in INOCA patients(sensitivity=82.9%,specificity=77.5%).Conclusions:SDNN is an independent predictor of CMVD in INOCA patients,and CMVD is one of the main causes of INOCA.Therefore,autonomic nervous sys

关 键 词：非阻塞性冠状动脉疾病 冠状动脉微循环功能障碍 心率变异性 微循环阻力指数 

分 类 号：R54[医药卫生—心血管疾病]