CAJ | 학술논문

目的探讨慢性阻塞性肺病(COPD)患者窦性心率震荡(HRT)及心率变异性(HRV)变化及临床意义.方法临床诊断为COPD老年患者59例,选择同期健康老年人30例为对照组.24 h动态心电图检测各组HRT参数:震荡初始(TO)和震荡斜率(TS)及HRV各项指标,肺功能检测,同时超声心动图测量左心室射血分数(LVEF)、右心房内径(RAD)、右心室内径(RVD)、右心室壁厚度(RVWT)等指标;组间比较且对HRT与HRV指标进行相关性分析.结果与对照组比较,COPD患者TO值显著增高[(-0.2±1.1)%与(-3.8±2.8)%,t=6.830,P＜0.01],TS值显著下降[(7.0±3.6)与(11.7±6.1)ms/RR,t=3.866,P＜0.01];HRV指标正常R-R间期的标准差(SDNN)、正常R-R间期的标准差的平均值(SDNNI)、SDNNI的标准差(SDANN)、相邻R-R间期之差的均方根值(rMSSD)和正常R-R间期标准差≥50 ms的百分数(PNN50)增加,且随肺动脉压力的增高而恶化.TO与SDANN,rMSDD呈负相关(r=-0.369,P＜0.05;r=-0.472,P＜0.01),TS和SDNN,SDANN,PNN50呈正相关(P＜0.05),与rMSDD无相关性(P＞0.05).结论 COPD患者HRT现象减弱,HRT和HRV变化随患者肺动脉压力的增加而恶化,联合检测对评价COPD患者自主神经功能状态及预后有较高临床价值.
목적 탐토만성조새성폐병(COPD)환자두성심솔진탕(HRT)급심솔변이성(HRV)변화급림상의의.방법 림상진단위COPD노년환자59례,선택동기건강노년인30례위대조조.24 h동태심전도검측각조HRT삼수:진탕초시(TO)화진탕사솔(TS)급HRV각항지표,폐공능검측,동시초성심동도측량좌심실사혈분수(LVEF)、우심방내경(RAD)、우심실내경(RVD)、우심실벽후도(RVWT)등지표;조간비교차대HRT여HRV지표진행상관성분석.결과 여대조조비교,COPD환자TO치현저증고[(-0.2±1.1)%여(-3.8±2.8)%,t=6.830,P＜0.01],TS치현저하강[(7.0±3.6)여(11.7±6.1)ms/RR,t=3.866,P＜0.01];HRV지표정상R-R간기적표준차(SDNN)、정상R-R간기적표준차적평균치(SDNNI)、SDNNI적표준차(SDANN)、상린R-R간기지차적균방근치(rMSSD)화정상R-R간기표준차≥50 ms적백분수(PNN50)증가,차수폐동맥압력적증고이악화.TO여SDANN,rMSDD정부상관(r=-0.369,P＜0.05;r=-0.472,P＜0.01),TS화SDNN,SDANN,PNN50정정상관(P＜0.05),여rMSDD무상관성(P＞0.05).결론 COPD환자HRT현상감약,HRT화HRV변화수환자폐동맥압력적증가이악화,연합검측대평개COPD환자자주신경공능상태급예후유교고림상개치.
Objective To explore the clinical significance of sinus heart rate turbulence (HRT)and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease(COPD).Methods The 59 moderate to severe COPD patients and 30 healthy subjects were enrolled in this study. The 24-hour holter monitor was used to screen the HRT onset (TO), turbulence slope (TS)and HRV. Pulmonary function tests and echocardiographic examination were performed for measuring left ventricular ejection fraction (LVEF), right atrial dimension (RAD), right ventricular dimension (RVD), right ventricular wall thickness (RVWT). Then all the parameters were compared between NC group and COPD group, and the relationship between HRT and HRV was investigated. Results Compared with control group, TO was significantly increased [(-0.2±1.1) % vs.(-3.8±2.8) %, t=6. 830,P＜0.01] and TS was decreased [(7.0±3.6) ms/RR vs. (11.7±6.1) ms/RR, t =3. 866, P＜0.01] in COPD group. In time domain HRV parameters, normal RR intervallerinin standart deviation(SDNN), standard deviation of normal-to-normal beats index (SDNNi), standard deviation of the averages of normal sinus to normal sinus (SDANN), mean squared differences of the successive RR intervals (rMSDD), fraction of consecutive normal sinus intervals that differ by more than 50 ms (PNN50) were significantly lower in COPD group than in control group(P＜0. 05). TO was negatively correlated with SDANN and rMSDD (r=-0. 369, P＜0. 05; r=-0.472, P＜0.01).TS was positively correlated with SDNN, SDANN and PNN50 (all P＜0.05), but had no correlation with rMSDD (P＞0. 05). Conclusions HRT and HRV are dramatically blunted in COPD patients.Combination of HRV and prognosis. and HRT may be simple and elegant ways for evaluating cardiac autonomic functions.