心率变异性与分支动脉粥样硬化病患者的早期神经功能恶化和转归不良的相关性  

Correlation between heart rate variability and early neurological deterioration and poor outcomes in patients with branch atheromatous disease

作　　者：张婷[1] 刘凌云[2] 李梦凡[2] 冷冰 高艳玲 张金彪[2] 李振光[2] Zhang Ting;Liu Lingyun;Li Mengfan;Leng Bing;Gao Yanling;Zhang Jinbiao;Li Zhenguang(Weifang Medical University,Weifang 261053,China;Department of Neurology,Weihai Municipal Hospital,Weihai 264200,China)

机构地区：[1]潍坊医学院,潍坊261053 [2]威海市立医院神经内科,264200

出　　处：《国际脑血管病杂志》2022年第12期897-903,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨心率变异性(heart rate variability,HRV)与分支动脉粥样硬化病(branch atheromatous disease,BAD)患者早期神经功能恶化(early neurological deterioration,END)和转归不良的相关性。方法前瞻性纳入2020年9月至2022年9月在威海市立医院神经内科住院治疗的BAD患者。END定义为入院72 h内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)总分较基线增加≥2分或运动项目评分增加≥1分。转归不良定义为发病后6个月时改良Rankin量表评分>2分。采用多变量logistic回归分析明确HRV参数是否为BAD患者END和转归不良的独立影响因素。结果共纳入117例BAD患者,男性76例(65.0%),年龄(64.27±6.95)岁,38例(32.4%)发生END,21例(17.9%)转归不良。END组相差>50 ms的相邻R-R间期占R-R间期总数百分比(percentage of the number of pairs of adjacent R-R intervals differing by more than 50 ms,pNN50)、相差>50 ms的相邻R-R间期数(number of adjacent R-R intervals differing by more than 50 ms,NN50)、低频功率(power in low frequency range,LF)和高频功率(power in high frequency range,HF)显著低于非END组,LF/HF比值显著高于非END组(P均<0.05);转归不良组全部窦性心搏R-R间期标准差(standard deviation of the R-R interval,SDNN)、R-R间期平均值标准差(standard deviation of the average of R-R intervals in all 5-min segments,SDANN)和HF显著低于转归良好组。多变量logistic回归分析显示,HF[优势比(odds ratio,OR)0.994,95%置信区间(confidence interval,CI)0.991~0.998;P<0.001]为BAD患者END的独立保护因素,LF/HF比值(OR 1.455,95%CI 1.056~2.005;P=0.022)为BAD患者END的独立危险因素;SDANN(OR 0.997,95%CI 0.993~0.999;P=0.023)为BAD患者转归良好的独立保护因素。结论HF和LF/HF比值是BAD患者END的独立影响因素,SDANN是BAD患者转归不良的独立影响因素,提示自主神经功能障碍参与了BAD患者END和转归不良的病理生理学机制。Objective To investigate the correlation between heart rate variability(HRV)and early neurological deterioration(END)and poor outcomes in patients with branch atheromatous disease(BAD).Methods Patients with BAD admitted to the Department of Neurology,Weihai Municipal Hospital from September 2020 to September 2022 were enrolled prospectively.END was defined as an increase of≥2 points in the total score of the National Institutes of Health Stroke scale(NIHSS)or an increase of≥1 in motor item score within 72 h of admission compared with the baseline.Poor outcome was defined as the score of the modified Rankin Scale>2 at 6 months after the onset.Multivariate logistic regression analysis was used to determine whether HRV parameters were the independent influencing factors of END and poor outcomes in patients with BAD.Results A total of 117 patients with BAD were enrolled,including 76 males(65.0%),aged 64.27±6.95 years.Thirty-eight patients(32.4%)had END,and 21(17.9%)had poor outcomes.Percentage of the number of pairs of adjacent R-R intervals differentiating by more than 50 ms(pNN50),number of adjacent R-R intervals differentiating by more than 50 ms(NN50),power in low frequency range(LF)and power in high frequency range(HF)in the END group were significantly lower than those in the non-END group,and the LF/HF ratio was significantly higher than the non-END group(all P<0.05).The standard deviation of the R-R interval(SDNN),standard deviation of the average of R-R intervals in all 5-min segments(SDANN),and HF in the poor outcome group were significantly lower than those in the good outcome group.Multivariate logistic regression analysis showed that HF(odds ratio[OR]0.994,95%confidence interval[CI]0.991-0.998;P<0.001)was an independent protective factor of END in patients with BAD,and LF/HF ratio(OR 1.455,95%CI 1.056-2.005;P=0.022)was an independent risk factor for END in patients with BAD;SDANN(OR 0.997,95%CI 0.993-0.999;P=0.023)was an independent protective factor of good outcomes in patients with BAD.Conclusion

关 键 词：卒中 颅内动脉硬化 心率 心电描记术 疾病恶化 治疗结果 危险因素 

分 类 号：R543.5[医药卫生—心血管疾病]