CAJ | 학술논문

目的：探讨不同合并症老年冠心病住院患者心率变异性（ heart rate variability，HRV）及心脏结构功能的改变及临床意义。方法收集老年冠心病住院患者143例，按合并症分为冠心病未合并高血压及2型糖尿病者（ T0组）31例，合并有高血压者（T1组）48例，合并2型糖尿病者（T2组）30例，合并高血压及2型糖尿病者（T3组）34例。比较4组患者的HRV指标、QTc间期及心脏结构功能指标，评估心脏自主神经及心脏结构功能改变。结果 SDNN、SDNN index、rMSSD、PNN50、HRV三角指数T3组较T0、T1、T2降低（ P ＜05．05），夜间平均心率与QTc间期T3组较T0、T1、T2升高（ P ＜0．05），T1、T2较T0组降低（ P ＜0．05）；SDANN index T1、T3组较T0组降低，QTc间期T1组较T3组延长（ P ＜0．05）。 LVEF T3组较T0、T1、T2降低（ P ＜0．05），LVEDV、LVESV T3组较T0、T1、T2增大（ P ＜0．05），E／A T3组较T0降低（ P ＜0．05），左心房内径（LA）T3组较T0增大（ P ＜0．05）。SDNN与LA、LVEDV、LVESV呈负相关，与LVEF、E／A呈正相关（ P ＜0．05）；rMSSD与LVEF、E／A呈正相关（ P ＜0．05）；HRV三角指数与LVEDV呈负相关，与LVEF呈正相关（ P ＜0．05）；QTc间期与LVEDV、LVESV呈正相关，与LVEF呈负相关（ P ＜0．05）。结论同时合并高血压及2型糖尿病的老年冠心病患者心脏自主神经功能及心脏结构功能均受损严重，HRV可以反映心脏结构的重构严重程度及心脏功能的损坏程度。
목적：탐토불동합병증노년관심병주원환자심솔변이성（ heart rate variability，HRV）급심장결구공능적개변급림상의의。방법수집노년관심병주원환자143례，안합병증분위관심병미합병고혈압급2형당뇨병자（ T0조）31례，합병유고혈압자（T1조）48례，합병2형당뇨병자（T2조）30례，합병고혈압급2형당뇨병자（T3조）34례。비교4조환자적HRV지표、QTc간기급심장결구공능지표，평고심장자주신경급심장결구공능개변。결과 SDNN、SDNN index、rMSSD、PNN50、HRV삼각지수T3조교T0、T1、T2강저（ P ＜05．05），야간평균심솔여QTc간기T3조교T0、T1、T2승고（ P ＜0．05），T1、T2교T0조강저（ P ＜0．05）；SDANN index T1、T3조교T0조강저，QTc간기T1조교T3조연장（ P ＜0．05）。 LVEF T3조교T0、T1、T2강저（ P ＜0．05），LVEDV、LVESV T3조교T0、T1、T2증대（ P ＜0．05），E／A T3조교T0강저（ P ＜0．05），좌심방내경（LA）T3조교T0증대（ P ＜0．05）。SDNN여LA、LVEDV、LVESV정부상관，여LVEF、E／A정정상관（ P ＜0．05）；rMSSD여LVEF、E／A정정상관（ P ＜0．05）；HRV삼각지수여LVEDV정부상관，여LVEF정정상관（ P ＜0．05）；QTc간기여LVEDV、LVESV정정상관，여LVEF정부상관（ P ＜0．05）。결론동시합병고혈압급2형당뇨병적노년관심병환자심장자주신경공능급심장결구공능균수손엄중，HRV가이반영심장결구적중구엄중정도급심장공능적손배정도。
Objective To investigate the heart rate variability ( HRV) in elderly patients with coronary heart disease ( CHD) complicated by hypertension and/or type 2 diabetes mellitus, and to explore the changes of cardiac structure and function and its clinical signioficance.Methods One hundred and forty-three elderly patients with CHD,according to their complications,were divided into four groups:simple CHD group (T0 group, n =31),CHD+hypertension group (T1 group, n=48), CHD+type 2 diabetes mellitus group (T2 group, n =30),CHD+hypertension+type 2 diabetes mellitus group (T3 group, n =34).The HRV indexes,QTc interval, cardiac structure and function were observed and compared among the four groups to evaluate the changes of cardiac autonomic nerve,cardiac structure and function.Results SDNN,SDANN index, SDNN index,rMSSD, PNN50 and HRV triangular index in T3 group were significantly lower than those in the other three groups ( P <0.05).In T3 group they were significantly increased,as compared with those in the other three groups ( P <0.05).The SDNN,SDNN index, rMSSD,HRV triangular index in T1 group and T2 group were significantly decreased,as compared with those in T0 group ( P <0.05).SDANN index in T1 and T3 group was significantly lower than that in T0 group,however, QTc interval in T1 group was obviously longer than that in T3 group ( P <0.05).LVEF in T3 group was significantly lower than that in T0,T1,T2 groups ( P <0.05),however,LVEDV and LVESV in T3 group were obviously increased,as compared with those in T0,T1,T2 groups ( P <0.05) .E/A in T3 group was significantly lower than that in T0 group ( P <0.05),but LA in T3 group was obviously increased ( P <0.05).SDNN was negatively correlated to LA, LVEDV,LVESV,however,which was positively correlated to LVEF and E/A ( P <0.05).The rMSSD was positively related with LVEF and E/A ( P <0.05) .HRV triangular index was negatively correlated to LVEDV,however, which was positively related with LVEF ( P <0.05) .QTc interval was positively related with LVEDV and LVESV,however,which was negatively correlated to LVEF ( P <0.05).Conclusion The heart autonomic nervous function and cardiac structure in elderly patients with coronary heart disease complicated by hypertension and type 2 diabetes mellitus are severely damaged,however, HRV can reflect the the severity of heart structure remodeling and the damage degree of heart function.