高血压患者心率变异性的性别差异及年龄影响

Differences of gender and effect of aging for heart rate variability on hypertensive patients

目的探讨性别和年龄对高血压患者心率变异性(HRV)的影响。方法采用24h动态心电图(Holter)评价300例高血压患者HRV的时域和频域指标,并将患者分为男性组(163例)和女性组(137例),再根据年龄分为≤65岁组(130例)和>65岁组(170例),分别比较不同性别和不同年龄组间HRV的差别,并对性别和年龄与HRV各指标间的相关性进行了分析。结果男性组极低频功率(VLF)、低频功率/高频功率(LF/HF)明显大于女性组(分别P=0.017和P=0.0002),标化HF(HFnorm)则明显低于女性组(P<0.0001),但是这种性别的差异仅发生在≤65岁组中。单变量回归分析显示男性与VLF、LF/HF相关较密切(分别r=-0.132,P=0.02和r=-0.176,P=0.002),女性与HFnorm相关较密切(r=0.215,P<0.0001),这种相关性也只出现在≤65岁组中,多变量回归分析只HFnorm与性别独立相关(r=0.215,P<0.0001)。≤65岁组总功率(TP)(P=0.011)、VLF(P=0.001)、低频功率(LF)(P=0.005)、标化低频功率(LFnorm)(P=0.0001)和LF/HF(P=0.001)明显大于>65岁组,而rMSSD(P=0.002)、PNN50(P=0.007)、HFnorm(P=0.031)则明显低于>65岁组,单变量回归分析除PNN50外,年龄与HRV各指标均具有显著的相关性,多变量回归分析年龄与LFnrom、LF、rMSSD独立相关(r=0.432,P<0.0001)。结论以上结果提示中年期女性高血压患者自主神经调节紊乱可能比男性更明显;老年高血压患者自主神经调节损害比中年患者更显著。

Objective The aim of this study to evaluate differences of gender and effects of aging for heart rate variability （HRV） on hypertensive patients. Methods time domain parameter and frequency domain parameter of HRV were assessed in 24-hour Holter ECG, three hundred hypertensive patients were divided into the two correspondence groups： male group （ N= 163 ） and female group （N= 137）,465 year group （N= 130） and 〉65 year group （N= 170）, differences of HRV parameter between corre-spond groups have been compared, and correlation of gender and aging with HRV parameter have been analysis. Results VLF,LF/HF of male group was significantly higher than that female group（ P = 0. 017 and P = 0. 000 2 respectively）, and HFnorm of male group was significantly lower than that female group（P 〈 0. 000 1 ）, but gender-related differences of HRV parameter onlyappeared in ≤65 year group, in a univariate regressive analysis, male （quantize for 1 ） was closely relate to VLF, LF/HF （ r =-0.132, P=0.02 and r= 0.176, P=0.002, respectively）, and female （quantize for2） was dcsely relate to HFnorm（r=0.215, P〈0.000 1）, but this correlation only appeared in 465 year group, in a multivariate regressive analysis, gender was indepdendy relate to HFnorm（ r=0.215, P〈0.000 1）. TP （P=0.011）, VLF （P=0.001）, LF （P=0.005）, LFnorm（P=0.000 1） and LF/HF（P=0.001） of 465 year group was significantly higher than that 〉65 year group, and rMSSD（P=0. 002 ）, PNN50 （ P = 0. 007） and HFnorm （ P = 0.031 ） was significantly lower than that 〉 65 year group, in a univariate regressive analysis, all HRV parameter, except PNN50, were closely related to aging, in a multivariate regressive analysis, age was independently related to LFnorm, LF and rMSSD （ r = 0. 432, P 〈 0. 000 1 ）. Conclusion this result may suggest that autonomic function modtulation turbutence of middle-aged hypertensive women were marked compared with hypertensive men, and autonomic cfunction modulation of agedness hypertensive patients were significantly impaired than that middle-aged hypertensive patients.