CAJ | 학술논문

目的探讨不同类型原发性高血压患者窦性心率震荡(HRT)的特点,评估窦性HRT指标对原发性高血压患者心脏自主神经功能损害的价值.方法 107例原发性高血压患者(高血压组)和46例健康体检者(健康对照组)均接受24 h动态心电图(Holter)检查,根据血压昼夜节律特点将高血压组分为杓型高血压组38例、非杓型高血压组53例及反杓型高血压组16例,分别比较各组HRT和心率变异性(HRV)各项指标,并分析震荡初始(TO)、震荡斜率(TS)与24 h平均收缩压、舒张压等指标之间的关系.结果高血压组TO、TS、窦性RR间期标准差(SDNN)与健康对照组比较,差异均有统计学意义(P＜0.05).非杓型高血压组及反杓型高血压组TO明显高于健康对照组(P＜0.05),TS则明显低于健康对照组(P＜0.05);而杓型高血压组TO、TS与健康对照组比较差异均无统计学意义(P＞0.05).同时非杓型高血压组和反杓型高血压组的TO明显高于杓型高血压组,TS则明显低于杓型高血压组,差异均有统计学意义(P＜0.05).相关性分析显示,TO与平均心率和年龄呈正相关(Spearman等级相关系数=0.265,P=0.004;Spearman等级相关系数=0.217,P=0.018),与SDNN和左室射血分数(LVEF)呈负相关(Spearman等级相关系数=-0.287,P=0.002;Spearman等级相关系数=-0.179,P=0.049).TS与平均心率和年龄呈负相关(r=-0.335,P=0.015;r=-0.238,P=0.009),而与SDNN和LVEF呈正相关(r=0.540,P=0.001;r=0.432,P=0.001).结论在原发性高血压患者中,血压昼夜节律异常者窦性HRT减弱或消失,提示窦性HRT在评估原发性高血压患者心脏自主神经功能损害方面有一定价值.
목적 탐토불동류형원발성고혈압환자두성심솔진탕(HRT)적특점,평고두성HRT지표대원발성고혈압환자심장자주신경공능손해적개치.방법 107례원발성고혈압환자(고혈압조)화46례건강체검자(건강대조조)균접수24 h동태심전도(Holter)검사,근거혈압주야절률특점장고혈압조분위표형고혈압조38례、비표형고혈압조53례급반표형고혈압조16례,분별비교각조HRT화심솔변이성(HRV)각항지표,병분석진탕초시(TO)、진탕사솔(TS)여24 h평균수축압、서장압등지표지간적관계.결과 고혈압조TO、TS、두성RR간기표준차(SDNN)여건강대조조비교,차이균유통계학의의(P＜0.05).비표형고혈압조급반표형고혈압조TO명현고우건강대조조(P＜0.05),TS칙명현저우건강대조조(P＜0.05);이표형고혈압조TO、TS여건강대조조비교차이균무통계학의의(P＞0.05).동시비표형고혈압조화반표형고혈압조적TO명현고우표형고혈압조,TS칙명현저우표형고혈압조,차이균유통계학의의(P＜0.05).상관성분석현시,TO여평균심솔화년령정정상관(Spearman등급상관계수=0.265,P=0.004;Spearman등급상관계수=0.217,P=0.018),여SDNN화좌실사혈분수(LVEF)정부상관(Spearman등급상관계수=-0.287,P=0.002;Spearman등급상관계수=-0.179,P=0.049).TS여평균심솔화년령정부상관(r=-0.335,P=0.015;r=-0.238,P=0.009),이여SDNN화LVEF정정상관(r=0.540,P=0.001;r=0.432,P=0.001).결론 재원발성고혈압환자중,혈압주야절률이상자두성HRT감약혹소실,제시두성HRT재평고원발성고혈압환자심장자주신경공능손해방면유일정개치.
Objective To explore sinus heart rate turbulence (HRT) in patients with different subtypes of essential hypertension (EH), and analyze the relationship between HRT and autonomic nervous system function damage in these patients. Methods The study consisted of 107 patients with EH (EH group) and 46 controls (control group). Based on 24 hours dynamic electrocardiogram, all patients were divided into dipper,non-dipper,and anti-dipper blood pressure group. The indexes about HRT and heart rate variability (HRV) among these groups were calculated and compared,and the relationship between turbulence onset (TO),turbulence slope (TS) and 24 hours mean systolic blood pressure,diastolic blood pressure was analyzed. Results There were significant differences in TO,TS,SDNN between EH group and control group(P ＜ 0.05 ). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in control group( P ＜ 0.05 ), and TS was lower than that in control group(P ＜ 0.05 ). There was no significant difference in TO,TS between dipper blood pressure group and control group (P ＞ 0.05). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in dipper blood pressure group, but TS was lower than that in dipper blood pressure group (P ＜0.05). Correlation analysis showed that TO had positive relationship with average heart rate and age (rs = 0.265, P = 0.004;rs = 0.217, P = 0.018 ), but had negative correlation with SDNN and left ventricular ejection fraction (LVEF) (rx = -0.287,P = 0.002;rx =-0. 179, P = 0.049). Whereas, TS had negative correlation with average heart rate and age (r = -0.335, P =0.015 ;r = -0.238,P= 0.009), but had positive relationship with SDNN and LVEF(r = 0.540,P = 0.001 ;r =0.432,P = 0.001 ). Conclusions HRT of EH patients becomes significantly low. It suggests that the autonomic nerve function in EH patients be injured seriously.