CAJ | 학술논문

目的：：探讨急性冠脉综合征( acute coronary syndrome,ACS)病人窦性心率震荡( heart rate turbulence, HRT)的变化及其与冠状动脉病变程度、再发心脏事件风险的关系。方法：选择ACS病人108例,按冠状动脉造影( CAG)结果分为CAG阳性组58例；CAG阴性组50例。对2组进行24 h动态心电图、冠状动脉造影及心脏彩超检查,分别计算HRT中TO及TS值,同时获取心率变异性( SDNN)、左室射血分数( LVEF)等参数并进行TO、TS与冠状动脉病变严重程度、年龄、LVEF、LVEDD、SDNN等多因素相关性分析。结果：CAG阳性组较CAG阴性组TO值明显增高,TS值明显降低,差异有统计学意义(P<0.05)；冠状动脉双支病变、三支病变与单支病变相比,病变程度重时TO值高,TS值低,差异有统计学意义(P<0.05)；合并心脏事件ACS组与非合并心脏事件ACS组比较,TO值明显增高、TS、LVEF值显著缩小(P<0.05),而年龄、SDNN、RR间期平均值、HRV指数在两组之间差异无统计学意义(P>0.05)；单因素与多因素分析结果均显示,当TO与TS相结合作为一个变量时对再发心脏事件的预测价值最强(r=3.06,P<0.05)。结论：ACS病人TO值增高,TS值降低,存在HRT减弱现象；HRT异常发生率的高低与ACS病人病情严重程度存在一定相关性,指标TO、TS值可预测ACS病人自主神经损害及其严重程度；提示HRT指标可作为ACS病人病情严重程度的指标之一；HRT可作为ACS后再发心脏事件的有效预测因子。
목적：：탐토급성관맥종합정( acute coronary syndrome,ACS)병인두성심솔진탕( heart rate turbulence, HRT)적변화급기여관상동맥병변정도、재발심장사건풍험적관계。방법：선택ACS병인108례,안관상동맥조영( CAG)결과분위CAG양성조58례；CAG음성조50례。대2조진행24 h동태심전도、관상동맥조영급심장채초검사,분별계산HRT중TO급TS치,동시획취심솔변이성( SDNN)、좌실사혈분수( LVEF)등삼수병진행TO、TS여관상동맥병변엄중정도、년령、LVEF、LVEDD、SDNN등다인소상관성분석。결과：CAG양성조교CAG음성조TO치명현증고,TS치명현강저,차이유통계학의의(P<0.05)；관상동맥쌍지병변、삼지병변여단지병변상비,병변정도중시TO치고,TS치저,차이유통계학의의(P<0.05)；합병심장사건ACS조여비합병심장사건ACS조비교,TO치명현증고、TS、LVEF치현저축소(P<0.05),이년령、SDNN、RR간기평균치、HRV지수재량조지간차이무통계학의의(P>0.05)；단인소여다인소분석결과균현시,당TO여TS상결합작위일개변량시대재발심장사건적예측개치최강(r=3.06,P<0.05)。결론：ACS병인TO치증고,TS치강저,존재HRT감약현상；HRT이상발생솔적고저여ACS병인병정엄중정도존재일정상관성,지표TO、TS치가예측ACS병인자주신경손해급기엄중정도；제시HRT지표가작위ACS병인병정엄중정도적지표지일；HRT가작위ACS후재발심장사건적유효예측인자。
Objective:To observe the correlation between sinus heart rate turbulence ( HRT ) and coronary lesion, occurring heart incident. Methods:Selected 108 patients who had undergone 24h ambulatory electrocardiography ( AECG ) , selective coronary angiography ( CAG ) and ultrasonic cardiography in the same period. We obtain HRT,including turbulence onset( TO) and turbulence slope ( TS) ,heart rate variability ( HRV ) , left ventricular ejection fraction ( LVEF ) , etc. The groups were divided according to the results of CAG. Then all of the data of HRT which accepted from AECG were analyzed and compared between groups. And study of heart rate turbulence and other factors relationship. There are 58 patients in CAG (+) group and 50 patients in CAG (-) group. In CAG (+) group,the 14 patients are single coronary lesion,28 patients are double coronary lesion,16 patients are triplet coronary lesion. Results:The value of the HRT onset was significantly higher in CAG(+) group than that in CAG(-)group,(P<0. 05);the value of the HRT slope in CAG(+)group was significantly lower than that in CAG(-)group,(P<0.05). Statistic significance was found in the variables of turbulence onset ( TO ) and turbulence slope ( TS ) in the three groups of single, double and triplet coronary lesion,(P<0. 05). Classified the patients,the TO of event group of ACS is higher than the non-event group,(P<0. 05),the TS and LVEF of event group is lower than the non-event group,(P<0. 05);but there are no significantly difference in the age and HRV. Used the univariate and multivariate analysis it indicated that the combination of TO and TS was the strongest risk predictor. Conclusion:TO is increased and TS is decreased in the acute coronary syndrome patients. The correlation is exist between the change extend of TO、TS and the extent of coronary lesion,TO and TS can predict autonomic neuropathy and its extend. The TO of event group of ACS is higher than the non-event group,(P<0. 05),the TS and LVEF of event group is lower than the non-event group,(P<0. 05);but there are no significantly difference in the age and HRV. Used the univariate and multivariate analysis it indicated that the combination of TO and TS was the strongest risk predictor. HRT could serve as a strong predictor for the subsequent development of poor outcomes in ACS pa-tients.