不同中医证型高血压患者心率变异性及其影响因素分析(1)
摘要：目的 調查高血压患者证型分布情况，分析心率变异性(HRV)时域参数特征与影响因素的相关性。方法 纳入高血压患者515例，进行辨证分型，记录患者的人口学资料、实验室指标、危险因素及临床症状，并分析其相关性，采用24 h动态心电图记录HRV时域参数，比较不同中医证型HRV的5项时域参数[全程NN间期标准差(SDNN)、每5分钟SDNN的平均值(SDNN Index)、HRV指数(HRV Index)、相邻NN间期之差(PNN50)、全部相邻NN间期之差的均方根(RMSSD)]差异。结果 515例患者中，阴虚阳亢证、痰瘀互结证、肝火亢盛证、肾气亏虚证、痰湿壅盛证分别为160、136、83、69、67例。阴虚阳亢证、肾气亏虚证、肝火亢盛证SDNN较痰瘀互结证、痰湿壅盛证明显降低(P<0.05)；阴虚阳亢证、肝火亢盛证SDNN Index、HRV Index较痰湿壅盛证明显降低(P<0.05)；肾气亏虚证SDNN Index较痰湿壅盛证明显降低(P<0.05)；肾气亏虚证PNN50较阴虚阳亢证明显降低(P<0.05)；阴虚阳亢证、肾气亏虚证、肝火亢盛证RMSSD较痰瘀互结证明显降低(P<0.05)。判别分析显示，收缩压、舒张压、血压晨峰值(MBPS)、SDNN、SDNN Index、HRV Index、PNN50、RMSSD与辨证分型的诊断判别具有相关性。二分类Logistic回归分析显示，性别(女性)，失眠，收缩压升高，血压晨峰程度越大，SDNN Index、PNN50降低与阴虚阳亢证呈正相关；性别(女性)，高龄，收缩压与舒张压升高，SDNN、HRV Index、RMSSD降低与痰瘀互结证呈正相关；高龄，高血压家族史，收缩压升高，SDNN Index、HRV Index、PNN50降低与痰湿壅盛证呈正相关。结论 阴虚阳亢证、肝火亢盛证、肾气亏虚证高血压患者HRV时域参数明显降低，自主神经功能受损较重，阴虚阳亢证、痰瘀互结证、痰湿壅盛证与引发高血压患者心脑血管事件的影响因素关系较为密切。
关键词：高血压；中医证型；心率变异性；影响因素
DOI：10.3969/j.issn.1005-5304.2017.09.005
中图分类号：R259.441 文献标识码：A 文章编号：1005-5304(2017)09-0015-06
Analysis on Heart Rate Variability and Its Influencing Factors of Hypertensive Patients from Different TCM Syndrome LIU Zhi-jun1， JIN Hua2，3， SU Li-li2， ZHENG Long-fei2， LIU Shuang-fang2， CAO Qiang2， HAN Yan-ping1 (1. Affiliated Hospital of Gansu University of Chinese Medicine， Lanzhou 730000， China； 2. Gansu University of Chinese Medicine， Lanzhou 730020， China； 3. Gansu Province Key Laboratory of Traditional Chinese Medicine Prescription Excavation and Innovation and Transformation， Lanzhou 730020， China)
Abstract： Objective To investigate the syndrome type distribution of hypertensive patients； To analyze the correlation of characteristics of HRV time domain parameters and its influence factors. Methods Totally 515 cases of hypertensive patients were included and were put under syndrome type distribution. Demographic information， laboratory test parameters， risk factors and clinical symptoms were collected for correlation analysis. HRV time domain parameters were recorded by using 24 h ambulatory electrocardiogram. The differences in SDNN， SDNN Index， HRV Index， PNN50， and RMSSD of different TCM syndrome types were compared. Results Among 515 patients： 160 cases with hyperactivity of yang due to yin deficiency syndrome， 136 cases with turbid phlegm and blood stasis syndrome， 83 cases with overabundant liver-fire syndrome， 69 cases with deficiency of kidney qi， and 67 cases with abundant phlegm-dampness syndrome. By comparing different TCM syndromes， the level of SDNN was significantly reduced in the hyperactivity of yang due to yin deficiency syndrome， overabundant liver-fire syndrome，, http://www.100md.com(刘志军 金华 苏莉莉 郑龙飞 刘双芳 曹强)
关键词：高血压；中医证型；心率变异性；影响因素
DOI：10.3969/j.issn.1005-5304.2017.09.005
中图分类号：R259.441 文献标识码：A 文章编号：1005-5304(2017)09-0015-06
Analysis on Heart Rate Variability and Its Influencing Factors of Hypertensive Patients from Different TCM Syndrome LIU Zhi-jun1， JIN Hua2，3， SU Li-li2， ZHENG Long-fei2， LIU Shuang-fang2， CAO Qiang2， HAN Yan-ping1 (1. Affiliated Hospital of Gansu University of Chinese Medicine， Lanzhou 730000， China； 2. Gansu University of Chinese Medicine， Lanzhou 730020， China； 3. Gansu Province Key Laboratory of Traditional Chinese Medicine Prescription Excavation and Innovation and Transformation， Lanzhou 730020， China)
Abstract： Objective To investigate the syndrome type distribution of hypertensive patients； To analyze the correlation of characteristics of HRV time domain parameters and its influence factors. Methods Totally 515 cases of hypertensive patients were included and were put under syndrome type distribution. Demographic information， laboratory test parameters， risk factors and clinical symptoms were collected for correlation analysis. HRV time domain parameters were recorded by using 24 h ambulatory electrocardiogram. The differences in SDNN， SDNN Index， HRV Index， PNN50， and RMSSD of different TCM syndrome types were compared. Results Among 515 patients： 160 cases with hyperactivity of yang due to yin deficiency syndrome， 136 cases with turbid phlegm and blood stasis syndrome， 83 cases with overabundant liver-fire syndrome， 69 cases with deficiency of kidney qi， and 67 cases with abundant phlegm-dampness syndrome. By comparing different TCM syndromes， the level of SDNN was significantly reduced in the hyperactivity of yang due to yin deficiency syndrome， overabundant liver-fire syndrome，, http://www.100md.com(刘志军 金华 苏莉莉 郑龙飞 刘双芳 曹强)