慢性充血性心力衰竭患者心率变异性及其昼夜节律变化

Heart rate variability and its circadian rhythm in patients with chronic congestive heart failure

目的分析慢性充血性心力衰竭(CHF)患者心率变异性(HRV)及其昼夜节律的变化,了解CHF患者自主神经功能损害与心功能的关系。方法用24小时动态心电图分析38例CHF患者,20例心功能代偿的心血管病患者心功能代偿组,16例健康体检者对照组的HRV时域指标。比较三组间HRV指标的差异;计算CHF患者HRV昼夜指标差异,分析CHF患者24小时HRV指标变化与心功能NYHA分级的关系。结果心功能代偿组24小时HRV时域指标SDNN、SDANN和SDNNindex较对照组显著下降P<0.01、0.05和0.05rMSSD和pNN50与对照组无显著差别P>0.05;CHF组的HRV各指标均显著低于对照组均P<0.01且昼夜指标变化无差异;将CHF组分为心功能Ⅱ级组n=20和心功能≥Ⅲ级n=18两个亚组结果发现心功能≥Ⅲ级的HRV各指标明显低于心功能Ⅱ级组P<0.01。结论心血管病患者可能在心功能代偿期时自主神经的平衡就已受到损害当出现CHF时交感活性增强迷走神经张力进一步下降,自主神经调节昼夜节律性丧失,且HRV指标的下降与心功能损害程度相关因此HRV时域指标可作为评价CHF预后指标之一。

Objectives The aim of this study is to analysis heart rate variability (HRV) and its circadian rhythms in patients with chronic congestive heart failure(CHF), and to evaluate the relationship between cardiac function and the functional lesion of autonomic nerve. Methods HRV parameters were obtained from 24-hour ambulatory electrocardiogram recording. 24-hour HRV in time domain indices were compared in thirty-eight patients with congestive heart failure (CHF), twenty patients with cardiovascular diseases with compensated heart function (CVD) and sixteen healthy subjects (HS). Day and night HRV in patients with CHF were also compared Result HRV parameters,except rMSSD and pNN50, were significantly lower in CVD than in HS(P<0.05-0.01).Time domain indices of HRV were also significantly lower in CHF than in HS. (P<0.01), and there was no difference between day and night HRV in patients with CHF. These indices were markedly lower in patients with class III-IV cardiac function than in patients with class II cardiac function (P<0.01). Conclusion Imbalance of the autonomic nervous system were associated with cardiovascular diseases with compensated heart function. Sympathetic hyperactivity,lower tonic vagal activity and loss of circadian rhythms in CHF correlated with disease severity. Time domain indices of HRV can be regarded as one of markers of prognosis in patients with CHF.