自主神经活动评估指标与难治性血管迷走性晕厥心脏去神经消融术后复发的相关性分析  

Association Between Autonomic Nerve Activities and Vasovagal Syncope Recurrence Post Cardioneuroablation

作　　者：李甲坤 涂斌 胡锋 蔡锶敏 赖子浩 陈爱月 郑黎晖 姚焰 LI Jiakun;TU Bin;HU Feng;CAI Simin;LAI Zihao;CHEN Aiyue;ZHENG Lihui;YAO Yan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院、心律失常中心,北京100037

出　　处：《中国循环杂志》2023年第6期663-668,共6页Chinese Circulation Journal

基　　金：首都特色临床应用研究(Z191100006619019);国家重点研发计划(2017YFC1307800);中国医学科学院阜外医院高水平医院临床科研业务费(2022-GSP-QZ-4)。

摘　　要：目的:探讨自主神经活动评估指标与难治性血管迷走性晕厥(VVS)患者心脏去神经消融术后复发的相关性。方法:入选2017年8月至2020年5月在中国医学科学院阜外医院行心脏去神经消融术的难治性VVS患者147例,其中38例(25.8%)出现晕厥或晕厥前兆的复发(复发组),109例(74.2%)未复发(未复发组)。比较术后复发组与未复发组患者的心率变异性(HRV)、心率减速力(DC)、连续心率减速力(DRs)的差异性。结果:与未复发组相比,复发组患者男性比例更低(50.1%vs.26.3%,P=0.012),收缩压更低[(121.75±13.60)mmHg(1mmHg=0.133kPa)vs.(115.00±16.11)mmHg,P=0.004];复发组患者的基线全天DC[(10.33±3.01)ms vs.(8.28±4.01)ms,P=0.008]、日间DC[(10.09±3.13)ms vs.(7.97±4.12)ms,P=0.001]、夜间DC[(11.50±3.34)ms vs.(9.83±3.69)ms,P=0.020]均较低。两组患者的心率变异性分析—时域分析和频域分析相关指标差异均无统计学意义;两组患者的DRs指标全天连续心率减速力(ADR)1~ADR10差异均无统计学意义(P均>0.05)。多因素Logistic回归分析显示,性别、收缩压及日间DC是心脏去神经消融术后晕厥/晕厥前兆复发的独立危险因素。结论:VVS患者间存在迷走神经活动的差异。DC、HRV和DRs在自主神经功能评估中各有优势,相互补充。Objectives:This study aimed to investigate the association between autonomic nerve assessment indexes and recurrence of vasovagal syncope(VVS)post cardioneuroablation.Methods:One hundred and forty-seven patients with refractory VVS who underwent cardioneuroablation were included in this study.Association between heart rate variability(HRV)time domain indexes and frequency domain indexes,deceleration capacity(DC)and deceleration runs(DRs)and VVS recurrence post cardioneuroablation was analyzed.Results:Compared with the non-recurrence group,the proportion of male patients was lower(50.1%vs.26.3%,P=0.012)in the recurrence group.Recurrent patients had lower systolic blood pressure([121.75±13.60]mmHg[1 mmHg=0.133 kPa]vs.[115.00±16.11]mmHg,P=0.004).Compared with the non-recurrence group,the all-day DC([10.33±3.01]ms vs.[8.28±4.01]ms,P=0.008),and daytime DC([10.09±3.13]ms vs.[7.97±4.12]ms,P=0.001),the night DC([11.50±3.34]ms vs.[9.83±3.69]ms,P=0.020)were all significantly lower in the recurrence group.There was no significant difference in the relevant indexes of heart rate variability in time domain analysis and frequency domain analysis between the two groups.There was no significant difference in heart rate deceleration runs between the two groups.Multivariate Logistic regression analysis showed that sex,systolic blood pressure and daytime DC were independent risk factors of VVS recurrence post cardioneuroablation.Conclusions:There are differences in vagal activity among VVS patients.DC,HRV and DRs have their own advantages and complement each other in the assessment of autonomic nervous function.

关 键 词：血管迷走性晕厥 心脏去神经消融术 自主神经评估 预后 

分 类 号：R54[医药卫生—心血管疾病]