CAJ | 학술논문

目的：探讨冠心病患者接受介入治疗前后心脏变时性改变及其临床价值。方法记录冠心病患者治疗前后心脏变时性指标，包括运动最高心率与预测最大心率值之比（ rHR）、变时性指数（ CRI）和心率储备率（ HRR），并记录冠状动脉造影检查（ CAG）结果及Gensini评分。 LSD-t检验对比分析不同类型冠心病患者心脏变时性指标差异；接受介入治疗的患者，行独立两样本t检验比较治疗前后心脏变时性指标差异；介入治疗后Gensini 评分分组组间心脏变时性指标行SNK-q检验。Person相关分析评价心脏变时性指标与冠状动脉病变严重程度相关性。结果本研究共纳入339例冠心病患者：不稳定型心绞痛与无症状性心肌缺血组间CRI分别为0.80±0.11和0.89±0.07，组间差异具有统计学意义（ P ＜0.05）。接受介入治疗的冠心病患者，治疗前后rHR、CRI及HRR组间差异均具有统计学意义（ t ＝2.440，1.977，2.529， P均＜0.05），且三指标与冠状动脉病变严重程度呈负相关（ r ＝-0.686，-0.673，-0.672， P均＜0.05）。 SNK-q检验结果显示：Gensini评分＜20分与＞40分两组rHR、CRI及HRR心脏变时性指标组间差异具有统计学意义（ t ＝2.567，2.223，2.062， P均＜0.05）。结论心脏变时性指标rHR、CRI及HRR对于评价冠心病介入治疗前后心脏功能的改变有重要的临床价值，其与冠状动脉病变呈负相关。
목적：탐토관심병환자접수개입치료전후심장변시성개변급기림상개치。방법기록관심병환자치료전후심장변시성지표，포괄운동최고심솔여예측최대심솔치지비（ rHR）、변시성지수（ CRI）화심솔저비솔（ HRR），병기록관상동맥조영검사（ CAG）결과급Gensini평분。 LSD-t검험대비분석불동류형관심병환자심장변시성지표차이；접수개입치료적환자，행독립량양본t검험비교치료전후심장변시성지표차이；개입치료후Gensini 평분분조조간심장변시성지표행SNK-q검험。Person상관분석평개심장변시성지표여관상동맥병변엄중정도상관성。결과본연구공납입339례관심병환자：불은정형심교통여무증상성심기결혈조간CRI분별위0.80±0.11화0.89±0.07，조간차이구유통계학의의（ P ＜0.05）。접수개입치료적관심병환자，치료전후rHR、CRI급HRR조간차이균구유통계학의의（ t ＝2.440，1.977，2.529， P균＜0.05），차삼지표여관상동맥병변엄중정도정부상관（ r ＝-0.686，-0.673，-0.672， P균＜0.05）。 SNK-q검험결과현시：Gensini평분＜20분여＞40분량조rHR、CRI급HRR심장변시성지표조간차이구유통계학의의（ t ＝2.567，2.223，2.062， P균＜0.05）。결론심장변시성지표rHR、CRI급HRR대우평개관심병개입치료전후심장공능적개변유중요적림상개치，기여관상동맥병변정부상관。
Objecitve To investigate the changes of chronotropic response before and after percutaneous coronary intervention ( PCI)in patients with coronary disease .Methods A total of 339 patients with coronary disease was included in this study .All sub-jects underwent treadmill exercise test and coronary angiogram , and some patients underwent PCI if necessary .The parameters of chro-notropic response were recorded and analyzed , including ratio of the highest to predicted heart rates ( rHR) ,chronotropic response in-dex ( CRI) , and heart rate reserve ( HRR) .After coronary angiogram , the score of gensin was recorded and analyzed .Results There was significant difference in the parameter of CRI between unstable angina pectoris and silent myocardial ischemia groups ( P <0.05 ) , CRI were 0.80 ±0.11 and 0.89 ±0.07 , respectively .After coronary angiogram and PCI , there were significant differences in the parameters of rHR, CRI, and HRR between pre-therapy and post-treatment ( t =2.440, 1.977, 2.529, all P <0.05).A nega-tive correlation was found between the parameters of rHR , CRI, and HRR and the score of Gensin ( r =-0.686 , -0.673 , and-0.672, all P <0.05).The significant difference in rHR, CRI, and HRR existed between the groups of <20 and >40 ( t =2.567, 2.223, 2.062, all P <0.05).Conclusions Parameters (rHR, CRI, and HRR) had important clinical values in evaluating the changes of chronotropic response before and after PCI in patients with coronary disease with a negative correlation with the score of Gensin.