冠心病患者心率变异性与冠状动脉病变狭窄范围及严重程度的关系研究
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摘要
目的:探讨冠心病患者心率变异性(HRV)与冠状动脉病变狭窄范围及严重程度的关系。方法:选取上海市第十人民医院2015年1月至2018年7月期间收治的冠心病患者220例,所有患者均行冠脉造影及24 h动态心电图检查。按狭窄范围分为单支狭窄组(n=68)、双支狭窄组(n=82)、三支狭窄组(n=70),按狭窄严重程度分为轻度组(狭窄≤50%,n=62),中度组(50%<狭窄<70%,n=66),重度组(狭窄≥70%,n=92),另选取51例同期于我院体检的健康志愿者作为对照组。记录冠心病患者与对照组HRV各项指标,比较不同冠脉病变狭窄范围患者、不同狭窄严重程度患者正常平均N-N间期(SDNN)、正常相邻每5minR-R间期均数标准差(SDANN)、正常相邻正常N-N间期的均方根(RMSSD)、正常相邻间期差值高于50 ms心搏数占总心搏数的百分比(pNN50)、低频(LF)、高频(HF)及低频/高频比值(LF/HF)。结果:冠心病患者与对照组RMSSD、pNN50、LF、HF比较差异无统计学意义(P>0.05),冠心病患者SDNN、SDANN低于对照组,LF/HF值高于对照组(P<0.05)。不同冠脉狭窄范围、不同冠脉病变狭窄严重程度患者pNN50、LF、HF整体比较无统计学差异(P>0.05),随着冠脉狭窄范围的增加或狭窄病变严重程度的加重SDDN、SDANN、RMSSD逐渐降低,LF/HF值逐渐升高(P<0.05)。结论:HRV是评估心脏自主功能的良好指标,该指标中SDDN、SDANN、RMSSD、LF/HF值可作为评估冠心病患者冠状动脉的狭窄程度和狭窄范围的良好指标,具有重要的临床指导意义。
Objective: To investigate the relationship between heart rate variability(HRV) and the range of stenosis and severity of coronary artery stenosis in patients with coronary heart disease. Methods: 220 patients with coronary heart disease who were admitted to Shanghai Tenth People's Hospital from January 2015 to July 2018 were selected,all patients underwent coronary angiography and24-hour dynamic electrocardiogram examination. They were divided into single-vessel stenosis group(68 cases), double-vessel stenosis group(82 cases) and three-vessel stenosis group(70 cases) according to the range of stenosis. They were divided into mild group(stenosis≤50%, n=62), moderate group(50%0.05). The SDNN and SDANN of patients with coronary heart disease were lower than those of the control group, and the LF/HF value was higher than that of the control group(P<0.05). There were no significant differences in pNN50, LF and HF among patients with different coronary stenosis range and severity(P>0.05). With the increase of coronary stenosis or the severity of the severity of coronary stenosis,the SDDN,SDANN and RMSSD decreased gradually, the LF/HF value gradually increased(P<0.05). Conclusion: HRV is a good indicator for assessing cardiac autonomic function, the values of SDDN, SDANN, RMSSD and LF/HF can be used as a good index to evaluate the degree and range of coronary artery stenosis in patients with coronary heart disease, which have important clinical guiding significance.
Objective: To investigate the relationship between heart rate variability(HRV) and the range of stenosis and severity of coronary artery stenosis in patients with coronary heart disease. Methods: 220 patients with coronary heart disease who were admitted to Shanghai Tenth People's Hospital from January 2015 to July 2018 were selected,all patients underwent coronary angiography and24-hour dynamic electrocardiogram examination. They were divided into single-vessel stenosis group(68 cases), double-vessel stenosis group(82 cases) and three-vessel stenosis group(70 cases) according to the range of stenosis. They were divided into mild group(stenosis≤50%, n=62), moderate group(50%
引文
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[21]Misra DP,Agarwal V.CANTOS-is selective targeting of inflammation in atherosclerosis enough?[J].J R Coll Physicians Edinb,2018,48(3):246-247
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[23]Rai V,Agrawal DK.The role of damage-and pathogen-associated molecular patterns in inflammation-mediated vulnerability of atherosclerotic plaques[J].Can J Physiol Pharmacol,2017,95(10):1245-1253
[24]朱丽,黄鹤.IL-6及TNF-α表达与粥样斑块稳定性及冠心病的相关性分析[J].中国心血管病研究,2015,13(9):799-802
[25]Coggan JS,Keller D,CalìC,et al.Norepinephrine stimulates glycogenolysis in astrocytes to fuel neurons with lactate[J].PLo SComput Biol,2018,14(8):e1006392
[26]Bar S,Leviel F,Abou Arab O,et al.Dynamic arterial elastance measured by uncalibrated pulse contour analysis predicts arterial-pressure response to a decrease in norepinephrine[J].Br J Anaesth,2018,121(3):534-540
[27]罗春苗,高潮,冯俊,等.冠心病及合并糖尿病患者冠脉病变程度和同型半胱氨酸及心率变异性的相关性研究[J].安徽医药,2016,20(11):2090-2092,2093
[28]Maestri R,Raczak G,Danilowicz-Szymanowicz L,et al.Reliability of heart rate variability measurements in patients with a history of myocardialinfarction[J].Clin Sci(Lond),2009,118(3):195-201
[29]李昭蓉,何涛,秦超,等.3种传导异常心律失常的心率变异性分析[J].广西医科大学学报,2016,33(3):492-494
[30]陆艳,曹燕.心率变异性与急性冠脉综合征患者冠状动脉病变程度的相关性研究[J].实用心脑肺血管病杂志,2016,24(6):16-18
[2]武文峰,江龙,王春梅,等.早发冠心病患者的危险因素及冠脉病变特点研究[J].现代生物医学进展,2016,16(8):1537-1540
[3]Bi YF,Mao JY,Wang XL,et al.Study on syndrome differentiation and treatment in the management of chronic stable coronaryartery disease to improve quality of life[J].Medicine(Baltimore),2018,97(36):e12097
[4]Luo ZC,Zhai L,Dai X.Does a Nurse-Led Program of Support and Lifestyle Management for patients with coronary artery disease significantly improve psychological outcomes among the patients:Ameta-analysis[J].Medicine(Baltimore),2018,97(35):e12171
[5]Parikh P,Shah N,Ahmed H,et al.Coronary artery calcium scoring:Its practicality and clinical utility in primary care[J].Cleve Clin J Med,2018,85(9):707-716
[6]Peri-Okonny PA,Patel KK,Jones PG,et al.Low Diastolic Blood Pressure Is Associated With Angina in Patients With Chronic Coronary Artery Disease[J].J Am Coll Cardiol,2018,72(11):1227-1232
[7]Kim J,Park HY,Lim K.Effects of 12 Weeks of Combined Exercise on Heart Rate Variability and Dynamic Pulmonary Function in Obese and Elderly Korean Women[J].Iran J Public Health,2018,47(Suppl1):74-81
[8]Guo Y,Cao L,Zhou Y,et al.Cardiometabolic traits mediated the relationship from urinary polycyclic aromatic hydrocarbons metabolites to heart rate variability reduction:A community-based study[J].Environ Pollut,2018,243(Pt A):28-36
[9]Goit RK,Pant BN,Shrewastwa MK.Moderate intensity exercise improves heart rate variability in obese adults with type 2 diabetes[J].Indian Heart J,2018,70(4):486-491
[10]MirandaéJFP,Hoshi RA,Bittencourt MS,et al.Relationship between heart rate variability and subclinical thyroid disorders of the Brazilian Longitudinal Study of Adult Health(ELSA-Brasil)[J].Braz J Med Biol Res,2018,51(11):e7704
[11]侯艳杰,王伟芳,郝金凤,等.心率变异性在急性冠脉综合征患者不同血管病变支数的比较[J].河北医学,2015,(10):1681-1682
[12]Feng J,Wang A,Gao C,et al.Altered heart rate variability depend on the characteristics of coronary lesions in stable angina pectoris[J].Anatol J Cardiol,2015,15(6):496-501
[13]Halvorsen S,Storey RF,Rocca B,et al.Management of antithrombotic therapy after bleeding in patients with coronary artery diseaseand/or atrial fibrillation:expert consensus paper of the European Society of Cardiology Working Group on Thrombosis[J].Eur Heart J,2017,38(19):1455-1462
[14]Maheshwari A,Norby FL,Soliman EZ,et al.Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population:The Atherosclerosis Risk in Communities Study[J].PLo S One,2016,11(8):e0161648
[15]郝美嘉,陈文卫,王氡,等.冠心病患者颈动脉粥样硬化超声相关参数与病变严重程度的关系[J].现代生物医学进展,2017,17(12):2275-2278
[16]Alexander B,Baranchuk A,Haseeb S,et al.Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease[J].J Thorac Dis,2018,20(7):4328-4334
[17]Mohammadpour AH,Salehinejad Z,Elyasi S,et al.Evaluation of serum cathepsin D concentrations in coronary artery disease[J].Indian Heart J,2018,70(4):471-475
[18]Savonitto S,Ferri LA,Colombo D.Perimenopause vasomotor symptoms,coronary atherosclerosis and risk of myocardial infarction during menopause:the cardiologist's perspective[J].Prz Menopauzalny,2018,17(2):53-56
[19]Alissa EM,Helmi SR Al-Salmi MM.Relationship between diet quality and carotid intima-media thickness in people with and without carotid atherosclerosis[J].J Family Med Prim Care,2018,7(3):531-537
[20]李红艳,芦良花,秦历杰,等.老年冠心病患者中血尿酸对血管内皮功能紊乱的影响[J].中国急救医学,2017,37(5):446-449
[21]Misra DP,Agarwal V.CANTOS-is selective targeting of inflammation in atherosclerosis enough?[J].J R Coll Physicians Edinb,2018,48(3):246-247
[22]Zhang H,Niu H,Yuan X,et al.Trimetazidine combined with berberine on endothelial function of patients with coronary heart disease combined with primary hypertension[J].Exp Ther Med,2018,16(2):1318-1322
[23]Rai V,Agrawal DK.The role of damage-and pathogen-associated molecular patterns in inflammation-mediated vulnerability of atherosclerotic plaques[J].Can J Physiol Pharmacol,2017,95(10):1245-1253
[24]朱丽,黄鹤.IL-6及TNF-α表达与粥样斑块稳定性及冠心病的相关性分析[J].中国心血管病研究,2015,13(9):799-802
[25]Coggan JS,Keller D,CalìC,et al.Norepinephrine stimulates glycogenolysis in astrocytes to fuel neurons with lactate[J].PLo SComput Biol,2018,14(8):e1006392
[26]Bar S,Leviel F,Abou Arab O,et al.Dynamic arterial elastance measured by uncalibrated pulse contour analysis predicts arterial-pressure response to a decrease in norepinephrine[J].Br J Anaesth,2018,121(3):534-540
[27]罗春苗,高潮,冯俊,等.冠心病及合并糖尿病患者冠脉病变程度和同型半胱氨酸及心率变异性的相关性研究[J].安徽医药,2016,20(11):2090-2092,2093
[28]Maestri R,Raczak G,Danilowicz-Szymanowicz L,et al.Reliability of heart rate variability measurements in patients with a history of myocardialinfarction[J].Clin Sci(Lond),2009,118(3):195-201
[29]李昭蓉,何涛,秦超,等.3种传导异常心律失常的心率变异性分析[J].广西医科大学学报,2016,33(3):492-494
[30]陆艳,曹燕.心率变异性与急性冠脉综合征患者冠状动脉病变程度的相关性研究[J].实用心脑肺血管病杂志,2016,24(6):16-18