超高龄持续性心房颤动患者心率变异性与基础临床特征的关系分析  

Relationship between heart rate variability and baseline clinical characteristics in super-aged patients with persistent atrial fibrillation

作　　者：王小艳[1] 许健[1] 钱进[1] 姜苏蓉[1] 王森[1] WANG Xiaoyan;XU Jian;QIAN Jin;JIANG Surong;WANG Sen(Geriatric Cardiovascular Department,Jiangsu Provincial People′s Hospital,Nanjing,Jiangsu,210029)

机构地区：[1]江苏省人民医院老年心血管科,江苏南京210029

出　　处：《实用临床医药杂志》2024年第9期67-72,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省干部保健科研项目(BJ21019)。

摘　　要：目的 探讨超高龄(≥80岁)持续性心房颤动(简称房颤)患者的心率变异性(HRV)与基础临床特征的关系。方法 选取108例超高龄持续性房颤患者纳入房颤组,另选取127例超高龄窦性心律老人纳入对照组,监测24 h动态心电图,比较2组心率、HRV时域指标[正常RR间期标准差(SDNN)、全程每5 min RR间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(RMSSD)、全程记录中5 min NN间期标准差平均值(SDNN index)、心率变异指数(HRV index)和相邻NN间期差值>50 ms的心搏数占NN间期总搏数的百分比(PNN50)]。收集房颤患者的基础临床特征,采用多元线性回归分析探讨HRV时域指标与心率、基础临床特征的相关性。结果 房颤组的SDNN、RMSSD、HRV index、PNN50、SDNN index均高于对照组,差异有统计学意义(P<0.01)。多元线性回归分析结果显示,SDNN升高与高血压(P=0.001)、服用β受体阻滞剂(P=0.003)、心率慢(P<0.001)显著相关,RMSSD升高与高血压(P=0.040)、服用β受体阻滞剂(P=0.002)、心率慢(P<0.001)显著相关,HRV index升高与心力衰竭(P=0.003)、心率慢(P<0.001)显著相关,PNN50升高与心率慢(P=0.004)显著相关;SDNN index升高与服用β受体阻滞剂(P=0.002)、心率慢(P<0.001)显著相关,SDANN升高与高血压(P=0.006)、心率慢(P<0.001)、服用达比加群(P=0.021)显著相关。结论 超高龄持续性房颤患者的HRV与基础临床特征存在相关性,该现象可能源于自主神经系统的活动状态。Objective To investigate the relationship between heart rate variability(HRV)and baseline clinical characteristics in super-aged(≥80 years old)patients with persistent atrial fibrillation(AF).Methods A total of 108 super-aged patients with persistent AF were included in AF group,and 127 super-aged patients with sinus rhythm were included in control group.24-hour ambulatory electrocardiogram monitoring was conducted to compare heart rate and HRV time-domain indicators[standard deviation of normal RR intervals(SDNN),standard deviation of the average of normal to normal intervals(SDANN)every 5 minutes throughout the recording,mean of the sum of the squares of differences between adjacent N-N intervals(RMSSD),average value of standard deviation of 5-minute NN intervals throughout the recording(SDNN index),heart rate variability(HRV)index,and percentage of NN intervals with differences greater than 50 ms accounting for the total number of NN intervals(PNN50)].Clinical characteristics of AF patients were collected,and multiple linear regression analysis was used to explore the correlation between HRV time-domain indicators and heart rate and baseline clinical characteristics.Results SDNN,RMSSD,HRV index,PNN50,and SDNN index were higher in the AF group than in the control group(P<0.01).Multiple linear regression analysis showed that increased SDNN was significantly associated with hypertension(P=0.001),use ofβ-blockers(P=0.003),and slow heart rate(P<0.001).Increased RMSSD wassignificantly associated with hypertension(P=0.040),use ofβ-blockers(P=0.002),and slow heart rate(P<0.001).Increased HRV index was significantly associated with heart failure(P=0.003)and slow heart rate(P<0.001).Increased PNN50 was significantly associated with slow heart rate(P=0.004).Increased SDNN index was significantly associated with the use ofβ-blockers(P=0.002)and slow heart rate(P<0.001).Increased SDANN was significantly associated with hypertension(P=0.006),slow heart rate(P<0.001),and use of dabigatran(P=0.021).Conclusion There is a

关 键 词：超高龄 房颤 心率变异性 高血压 Β受体阻滞剂 达比加群 

分 类 号：R541.7[医药卫生—心血管疾病] R540.4[医药卫生—内科学] R319[医药卫生—临床医学]