冠心病严重度与心律变异的关系(1)
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【摘要】 目的 探讨冠心病(CAD)严重度对心率变异性(HRV)的影响及其关系,为诊断CAD提供更多依据。方法 选取CAD患者136例作为实验组,分别为SAP组、UAP组、NSTEMI组和STEMI组,每组34例,选取健康体检者34例作为正常对照组,所有入选对象于入院后24 h内行24 h动态心电图检查。结果 CAD患者HRV各时域指标SDNN、SDANN、SDNN Index、rMSSD及PNN50明显低于正常人,而STEMI组各HRV指标明显低于NSTEMI组、UAP组和SAP组,NSTEMI组各HRV指标明显低于UAP组和SAP组,UAP组各HRV指标明显低于SAP组,P<0.01,有统计学意义。结论 HRV可作为一个无创性指标间接反映CAD严重度,为CAD的临床诊断提供依据。
【关键词】 冠心病;心率变异性;时域指标
The relationship between CAD severity and heart rate variability in patiens with coronary artery disease
GAO Han-mei,CHEN Juan,SONG Chao-gong.The First Rongkang Hospital of Henan, Xinxiang 453003,China
【Abstract】 Objective To investigate the influence of coronary artery disease(CAD)severity to heart rate variability(HRV),providing support for more clinical diagnosis of CAD.Methods A total of 136 patiens with CAD(34 SAP,34 UAP,34 NSTEMI and 34 STEMI)were randomly recruited in this study and 34 healthy individuals were used as control.All subjests received 24-hour drnamic electrocardiography with 24 hours of admission.Results HRV in patients with CAD of all time -domain SDNN,SDANN,SDNN Index,rMSSD and PNN50 significantly lower than healthy people.While the STEMI group HRV index was significantly lower than the NSTEMI group,UAP group and SAP group,NSTEMI group HRV index was significantly lower than the UAP group and SAP group,UAP group HRV index was significantly lower than the SAP group,P<0.01,statistically significan.Conclusion HRV may be used as a noninvasive indicator for indirectly signaling the severity of CAD providing support for the clinical diagnosis of CAD.
【Key words】Coronary artery disease; Heart rate variability; Time-domain
作者单位:453003河南第一荣康医院心内科
心率变异性(HRV)是窦性心律在一定时间内周期性变化的现象,是反映交感和副交感神经张力及其平衡的重要指标。临床研究已经证实,HRV降低是独立于其他传统指标之外的,预测心脏性猝死和心肌梗死(MI)预后的有力指标[1,2]。冠心病(CAD)患者冠状动脉病变程度与HRV关系国内外报导较多,但结论不一,本研究通过比较心绞痛和MI患者的HRV,为CAD的诊断提供依据。
1 资料与方法
1.1 一般资料
1.1.1 入选标准 136例研究对象均为2007年3月至2009年11月在我科住院确诊的CAD患者,按2000年9月美国ACC/AHA制定的不稳定心绞痛/非ST段抬高心肌梗死治疗指南进行筛选。①ST段抬高急性心肌梗死(STEMI)患者:典型胸痛症状持续>30 min,相邻两个或更多导联的J点处有新的ST段抬高,在V1、V2或V3导联ST段≥0.2 mV,在I、aVL、II、aVF导联ST段≥0.1 mV,心电图呈动态演变。心肌酶谱检查结果异常且呈动态变化;②非ST段抬高心肌梗死/不稳定心绞痛(NSTEMI/UAP)患者:静息性心绞痛,新近发作性心绞痛,恶性心绞痛;相邻两个或更多导联出现新的ST段压低或(和)T波异常,心肌坏死标志物肌钙蛋白升高超过正常上限99%可信区间,CK-MB升高超过正常上限2倍,则可诊断为NSTEMI,反之,则诊断为UAP;③稳定型心绞痛(SAP)患者:劳力性心绞痛,反复发作,持续2个月以上,发作性质基本稳定或平板运动试验阳性 ......
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