心率变异性在病态窦房结综合征患者中特征及诊断价值  

Characteristics and diagnostic value of heart rate variability in patients with sick sinus syndrome

作　　者：张静华[1] 李平 郭华[1] 王随峰[1] 张扬辉 刘桂芝[1] ZHANG Jinghua;LI Ping;GUO Hua;WANG Suifeng;ZHANG Yanghui;LIU Guizhi(Department of Physical Diagnosis,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Medicine,Henan Medical College,Zhengzhou,Henan 451191,China)

机构地区：[1]郑州大学第一附属医院物理诊断科,河南郑州1450052 [2]河南医学高等专科学校临床医学院内科教研室,河南郑州451191

出　　处：《中华实用诊断与治疗杂志》2023年第8期757-761,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(2018020537);河南省科技攻关计划项目(212102310797)。

摘　　要：目的观察病态窦房结综合征(SSS)患者心率变异性(HRV)指标变化,探讨HRV在SSS患者中特征及对SSS的诊断价值。方法2014年7月—2021年12月郑州大学第一附属医院诊治SSS患者61例为SSS组,非心脏病患者195例为对照组,2组均行动态心电图检查,比较2组及2组不同年龄段患者24 h心率(最快心率、最慢心率、平均心率、总心率)、HRV指标[全部正常R-R间期标准差(SDNN)、每5 min正常R-R间期均值的标准差(SDANN)、全部相邻R-R间期差值的均方根(rMSSD)、相邻R-R间期差值>50 ms所占百分比(pNN50)]及R-R间期>2000 ms发生率。采用Pearson相关法分析最慢心率与HRV指标的相关性,采用多因素logistic回归分析SSS诊断的影响因素。结果SSS组24 h最快心率[(95±23)次/min]、最慢心率[(38±7)次/min]、平均心率[(56±9)次/min]、总心率[(80805±13240)次/min]均低于对照组[(121±17)、(52±6)、(74±7)、(106287±10602)次/min](P<0.05),SDNN[(175.26±51.00)ms]、SDANN[(143.79±50.43)ms]、rMSSD[(103.87±64.44)ms]、pNN50[(24.65±16.34)%]及R-R间期>2000 ms发生率(41.0%)均高于对照组[(128.85±31.75)ms、(116.11±30.38)ms、(36.16±19.77)ms、(7.36±7.33)%、0](P<0.05)。对照组不同年龄段患者24 h最快心率、平均心率、总心率、SDNN、SDANN、rMSSD、pNN50比较差异均有统计学意义(P<0.05),随年龄增长均呈逐渐降低趋势;对照组不同年龄段患者最慢心率比较差异无统计学意义(P>0.05);SSS组不同年龄段患者24 h最快心率、最慢心率、平均心率、总心率、SDNN、SDANN、rMSSD、pNN50及R-R间期>2000 ms发生率比较差异均无统计学意义(P>0.05)。对照组SDNN、SDANN、rMSSD、pNN50与最慢心率均呈负相关(r=-0.693,P<0.001;r=-0.667,P<0.001;r=-0.229,P=0.001;r=-0.498,P<0.001);SSS组SDNN、SDANN、pNN50与最慢心率均呈负相关(r=-0.585,P<0.001;r=-0.471,P<0.001;r=-0.468,P<0.001),rMSSD与最慢心率无相关性(r=-0.037,P=0.776)。最快心率(OR=0.926,95%CI:0.894~0.959,P<0.001)、最慢心Objective To observe the changes of heart rate variability(HRV)in patients with sick sinus syndrome(SSS),and to investigate the characteristics of HRV in patients with SSS and its diagnostic value.Methods From July2014 to December 2021,61 patients with SSS(SSS group)and 195 patients without heart disease(control group)were diagnosed and treated in the First Affiliated Hospital of Zhengzhou University.Dynamic electrocardiogram(DCG)examination was performed in both groups to compare the 24-h heart rate(maximum heart rate,minimum heart rate,average heart rate,total heart rate),HRV indicators[the standard deviation of normal R-R interval(SDNN),the standard deviation of all 5-min mean normal R-R intervals(SDANN),the root mean square of successive R-R intervals differences(rMSSD),the percentage of adjacent NN intervals differing by more than 50 ms(pNN50)]and the incidence of R-R interval>2000 ms between two groups and in patients with different ages in two groups.Pearson correlation analysis was done to assess the correlation between minimum heart rate and HRV indicators,and multivariate logistic regression analysis was done to evaluate the influencing factors of SSS diagnosis.Results The 24-h maximum heart rate,minimum heart rate,average heart rate and total heart rate were slower in SSS group[(95±23),(38±7),(56±9),(80805±13240)beats/min]than those in control group[(121±17),(52±6),(74±7),(106287±10602)beats/min](P<0.05),and the SDNN,SDANN,rMSSD,pNN50 and rate of R-R interval>2000 ms were higher in SSS group[(175.26±51.00)ms,(143.79±50.43)ms,(103.87±64.44)ms,(24.65±16.34)%,41.0%]than those in control group[(128.85±31.75)ms,(116.11±30.38)ms,(36.16±19.77)ms,(7.36±7.33)%,0](P<0.05).The 24-h maximum heart rate,average heart rate,total heart rate,SDNN,SDANN,rMSSD and pNN50showed significant differences among patients with different ages in control group(P<0.05),and showed a decreasing trend with the increase of age.There was no significant difference in the minimum heart rate in patients with different ages

关 键 词：病态窦房结综合征 心率变异性 动态心电图 

分 类 号：R541.7[医药卫生—心血管疾病]