特发性室性早搏与自主神经张力的关系

Relationship between occurrence of idiopathic premature ventricular contraction and autonomic nervous tension

目的探讨特发性室性早搏(室早)的发生与自主神经机制之间的关系。方法采用单中心回顾性研究方法,选择24 h动态心电图记录到频发室早(≥10000次/d或室早负荷≥10%)的156例特发性室早患者(室早组)和同期健康体检者84例(对照组)为研究对象。根据24 h动态心电图检查结果,计算心率变异性指标rMSSD、pNN50、高频功率(HF)、标准化的高频功率(HFnorm)、低频功率(LF)与HF的比值(LF/HF)。比较两组自主神经张力间的差异,并分析室早负荷与自主神经张力变化的关系。结果与对照组相比,室早组患者rMSSD、pNN50、HF和HFnorm均明显增加(P<0.01),LF/HF显著降低(P<0.01)。室早组患者24 h室早负荷与rMSSD、pNN50和HF呈正相关(相关系数分别为0.492、0.425、0.372,P<0.01),而与LF/HF呈负相关(相关系数为-0.206,P<0.05);其中28.8%(45/156)的患者每小时室早负荷与每小时HFnorm呈正相关,16.0%(25/156)的患者与每小时LF/HF呈正相关,53.8%(84/156)的患者与每小时HFnorm和每小时LF/HF均无相关性。结论部分特发性室早的发生与交感和(或)迷走神经张力变化相关。

Objective To investigate the relationship between the occurrence of idiopathic premature ventricular contraction(IPVC)and the mechanism of autonomic nerve.Methods In a single-center retrospective study approach,we selected 156 patients with IPVC[PVC group,with≥10000 times of PVCs per day recorded by 24-hour ambulatory electrocardiography(AECG)or PVC burden≥10%],and 84 physical examination subjects du-ring the same period(control group)as research subjects.According to the 24-hour AECG examination results,the following heart rate variability indexes were calculated,including rMSSD,pNN50,HF,HFnorm and LF/HF.We compared the autonomic nervous tension between the two groups,and analyzed the relationship between PVC burden and changes of autonomic nervous tension.Results The indexes of rMSSD,pNN50,HF and HFnorm in the PVC group are all significantly higher than those in the control group(P<0.01)while LF/HF is significantly lower(P<0.01).In the PVC group,the 24-hour PVC burden is positively correlated with rMSSD,pNN50 and HF(correlation coefficient r=0.492,0.425 and 0.372,respectively;P<0.01)while it is negatively correlated with LF/HF(r=-0.206,P<0.05).Hourly PVC burden is positively correlated with hourly HFnorm in 28.8%(45/156)of the enrolled IPVC patients,and it is positively correlated with hourly LF/HF in 16.0%(25/156)of IPVC patients.Among 53.8%(84/156)of IPVC patients,hourly PVC burden is correlated with neither hourly HFnorm nor hourly LF/HF.Conclusion In parts of patients,the occurrence of IPVC is associated with the changes of sympathetic and(or)parasympathetic nervous tension.