机构地区:[1]桐乡市第一人民医院放射科,314500 [2]桐乡市第一人民医院甲乳外科,314500
出 处:《心电与循环》2024年第1期39-43,47,共6页Journal of Electrocardiology and Circulation
摘 要:目的探讨慢性阻塞性肺疾病(COPD)合并肺心病患者定量CT肺功能参数与心率变异性(HRV)的关系。方法选择2020年3月至2021年12月桐乡市第一人民医院收治的COPD患者160例,其中75例单纯COPD患者作为COPD组,85例COPD合并肺心病患者作为肺心病组。根据肺心病诊断标准将肺心病组分为轻度亚组32例、中度亚组30例、重度亚组23例。另择同期本院健康志愿者65名作为对照组。3组对象均行胸部CT检查和24h动态心电图检查,比较组间定量CT肺功能参数,包括低密度衰减区占全肺体积比例(LAA%)、呼气末肺容积/吸气末肺容积(Vex/Vin)、呼气末与吸气末CT平均肺密度比值[MLD(ex/in)]及HRV参数[窦性RR间期标准差(SDNN)、每5 min窦性RR间期平均值的标准差(SDANN)、邻近窦性RR间期长度差的均方根(rMSDD)、相邻窦性RR间期之差>50 ms的心搏个数占所有心搏个数的百分数(PNN50)]。采用Pearson相关分析肺心病患者定量CT肺功能参数与HRV的关系。结果COPD组、肺心病组LAA%、Vex/Vin、MLD(ex/in)高于对照组,肺心病组上述指标高于COPD组,差异均有统计学意义(均P<0.01)。COPD组和肺心病组SDNN、SDANN、rMSSD、PNN50低于对照组,肺心病组上述指标低于COPD组,差异均有统计学意义(均P<0.01)。中度亚组、重度亚组LAA%、Vex/Vin、MLD(ex/in)高于轻度亚组,重度亚组上述指标高于中度亚组,中度亚组、重度亚组SDNN、SDANN、rMSSD、PNN50低于轻度亚组,重度亚组上述指标低于中度亚组,差异均有统计学意义(均P<0.01)。LAA%、Vex/Vin、MLD(ex/in)均与SDNN、SDANN、rMSSD及PNN50呈负相关(均P<0.05)。结论COPD合并肺心病患者定量CT肺功能参数与HRV参数均能反映患者病情严重程度,且两者呈负相关。Objective To assess the relation between quantitative CT lung function measurement and heart rate variability(HRV)in patients with cor pulmonale.Methods One hundred and sixty patients with chronic obstructive pulmonary disease(COPD)admitted to the First People's Hospital of Tongxiang City from March 2020 to December 2021 were selected.Among them,75 patients had pure COPD(COPD group)and 85 patients had COPD with cor pulmonale(cor pulmonale group).Cor pulmonale group was divided into mild subgroup(32 cases),moderate subgroup(30 cases)and severe subgroup(23 cases)based on diagnostic criteria of cor pulmonale.Sixty-five healthy volunteers were selected as a control group at the same time.All subjects underwent chest CT examination and 24-hour dynamic electrocardiogram examination.Quantitative CT parameters[low attenuation area percentage(LAA%),end-expiratory lung volume/end-inspiratory lung volume(Vex/Vin),ratio of end-expiration and end-inspiratory CT mean lung density[MLD(ex/in)],and HRV parameters[standard deviation of the normal to normal inter beat intervals(SDNN),standard deviation of average of N-N intervals(SDANN),root mean square of the successive differences(rMSSD),percentage of NN50 in the total number of N-N intervals(PNN50)]were compared between groups.The relationship between quantitative CT parameters and HRV in patients with cor pulmonale was analyzed by Pearson correlation.Results The LAA%,Vex/Vin and MLD(ex/in)were significantly higher in COPD group and cor pulmonale group than in the control group(all P<0.01),and higher in cor pulmonale group than in COPD group(all P<0.01).The SDNN,SDANN,rMSSD and PNN50 were significantly lower in COPD group and cor pulmonale group than in the control group(all P<0.01),and lower in cor pulmonale group than in COPD group(all P<0.01).There were significant differences in LAA%,Vex/Vin,and MLD(ex/in)between any two subgroups,with the severe subgroup having the highest and the mild subgroup having the lowest(all P<0.01).There were significant differences in SDNN,SDNN,rM
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