直立倾斜试验平卧位阶段心率变异频谱指标与Ⅱ型血管迷走性晕厥的相关性  

Correlation between Frequency Spectrum of Heart Rate Variation and TypeⅡVasovagal Syncope during Recumbent Position in Head-up Tilt Test

作　　者：徐元园 何佳 刘瑞鹏 李志强[1] 卢国英 樊晓寒 XU Yuanyuan;HE Jia;LIU Ruipeng;LI Zhiqiang;Luguoying;FAN Xiaohan(Department of Cardiovascular and ECG Center,Binzhou City People's Hospital,Binzhou 256600,Shandong,China;Functional Testing Center,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100032,China)

机构地区：[1]滨州市人民医院心血管内科-心电中心,山东滨州256600 [2]中国医学科学院阜外医院功能检测中心,北京市100032

出　　处：《中国分子心脏病学杂志》2023年第5期5635-5639,共5页Molecular Cardiology of China

摘　　要：目的探讨在直立倾斜试验(head-up tilt test,HUTT)中平卧位时的心率变异频域指标与心脏抑制型(Ⅱ型)血管迷走性晕厥(vasovagal syncope,VVS)发生的相关性。方法回顾性分析2020年2月至2023年2月在两个医疗中心因疑似VVS行HUTT患者共1760例,根据HUTT反应结果分为Ⅰ型(316例)、Ⅱ型(55例)、Ⅲ型(284例),以心脏抑制型病例进行年龄、性别配对,匹配筛选出I型混合型57例和Ⅲ型血管抑制型58例,按1:3比例筛选出阴性对照组患者149例,收集入选患者平卧位阶段心率变异频谱指标。结果各亚组的心率变异频谱分别与HUTT阴性组比较,结果发现Ⅱ型心脏抑制组平卧位的低频(low frequency,LF)和LF/高频(high frequency,HF)较对照组显著升高,Ⅰ型和Ⅲ型患者平卧位LF和LF/HF与阴性组无明显变化。Ⅱ型心脏抑制组患者平卧位的LF、LF/HF的受试者操作特征(receiver operator characteristic,ROC)曲线下面积分别为0.610(P=0.016),0.718(P<0.001),LF/HF界值为1.17。Logistic回归分析校正年龄、性别后,LF/HF>1.17与Ⅱ型心脏抑制VVS发生显著相关(OR=1.76,95%CI:1.147~2.700,P=0.01)。结论平卧位心率变异频谱指标与血管迷走性晕厥患者中的心脏抑制型反应有关。Objective To investigate the correlation of frequency domain analysis of heart rate variability(HRV)in supine position during head-up tilt test(HUTT)with the occurrence of cardiac inhibitory type(typeⅡ)vasovagal syncope(VVS).Methods A total of 1760 patients who underwent HUTT due to suspected vasovagal syncope in two medical centers from February 2020 to February 2023 were retrospectively selected.According to the HUTT reaction results,they were divided into typeⅠ(316 cases),typeⅡ(55 cases),and typeⅢ(284 cases).Age and gender matching was performed on patients with cardiac depression.57 patients with mixed typeⅠand 58 patients with vascular depression typeⅢwere matched and selected,and 149 patients in the negative control group were selected based on a 1:3 ratio.Heart rate variability spectrum indicators of selected patients during recumbent position were collected.Results Compared with the HUTT negative group,the frequency spectrum of heart rate variability in the three subgroups showed that the mean lying position LF and LF/HF in the typeⅡcardiac suppression group were significantly higher than those in the control group,while the lying position LF and LF/HF in the typeⅠandⅢpatients had no significant changes compared with the negative group.The area under the ROC curve for LF and LF/HF in the prone position of patients with typeⅡcardiac depression was 0.610(P=0.016),0.718(P<0.001),and the LF/HF threshold was 1.17.Logistic regression analysis adjusted for age and gender showed a significant correlation between LF/HF>1.17 and typeⅡcardiac suppression VVS(OR=1.76,95%CI:1.147-2.700,P=0.01).Conclusion The frequency spectrum of heart rate variability in prone position is related to the cardiac inhibitory response in patients with vasovagal syncope.

关 键 词：心率变异性 血管迷走性晕厥 心脏抑制型 直立倾斜试验 

分 类 号：R54[医药卫生—心血管疾病]