24小时心率变异三角指数作为冠心病心绞痛、心肌梗死患者预后危险性分级的定量指标的研究

The Study of 24 Hours HR Variation Triangle Index as the Quantitative Index to Grade the Prognostic Hazard of the Patients with Angina Pectoris and Myocardial Infarction

目的:24小时心率变异三角指数作为冠心病(CHD)心绞痛(AP)、心肌梗死(MI)患者预后危险性分级的定量指标的研究。方法:对CHDAP组62例,急性心肌梗死(AMI)80例,陈旧性心肌梗死(OMI)80例,正常组60例,均采用美国PI200A型动态心电图进行心电实时监测,24小时心率变异三角指数和24小时高频成份的测定按ESC和NASP推荐的方法。融入加权、综合三角指数来衡量24小时心率变异三角指数对CHDAP、MI及其并发症患者与正常组进行对照分析。结果:①AMI组,OMI组,AP组心率变异三角指数(HRVTI)显著低于正常对照组[(25·4±7·6)/(26·5±8·5)/(27·6±9·4)/(37·3±12),P<0·001]。②AMI组:HRVTI前壁MI,低于下壁MI[(23·5±3·65)/(27·2±7·85),P<0·05];广泛前壁MI低于广泛下壁MI组[(22·4±6·1)/(28·5±8·5),P<0·01]。③OMI组:前壁与下壁梗死、HRVTI的差异消失,然而多部位梗死HRVTI低于单一部位MI[(23·01±73·05)/(27·4±8·1),P<0·05]。④32例合并心力衰竭的患者HRVTI明显低于68例无合并症的MI患者[(18·8±6·25)/(30·0±7·0),P<0·001]。⑤48例合并室性心律失常的患者HRVTI低于38例无并发症MI患者,[(24·58±6·05)/(29·88±7·1),P<0·001]。⑥按HRVTI>25为正常标准,≤25者预后不良发生率和猝死率分别为>25者8·8倍(24/90∶4/132和8·1倍(11/90∶2/132)的构成比,按HRVTI的降低的程度制定四级标准,即≤25轻度异常。≤20中度异常,≤15重度异常,≤10为极度异常。结论:HRVTI降低的AP、MI患者预后不良,HRVTI降低的程度与MI的部位、面积及合并症相关;且与高频成份降低有关。HRVTI≤25轻度异常。≤20中度异常,≤15重度异常,≤10为极度异常,提示CHDAP,MI患者迷走神经系统功能严重受损,易发生持续性室性心动过速,心室颤动和/猝死。

Objective： The study of the relation of 24 hours HR variation triangle index and angina pectoris and myocardial infarction of CHD, to propose a new quantitative index to grade the prognostic hazard of angina pectoris and myocardial infarction, and explore it＇s variation mechanism and clinical significance. Methods： 62 cases of angina pectoris group, 80 cases of AMI group, 80 cases of OMI group and 60 cases of normal group were all abundant time monitored by ambulatory ECG （USA PI 200A）, 24 hours HR variation triangle index and 24 hour high frequence component were detected by the methods recommended by ESC and NASP. Incorporate with weight and combine triangle index to measure 24 hour HR variation triangle index for the patients with angina pectoris and myocardial infarction of CHD and complications meanwhile constract and analysis with normal group. Result： （1） The HR variation triangle indices in AMI, OMI and angina pectoris group were obviously lower than normal group [ （25.4±7.6） /9 （26.5±8.5） / （27.6±9.4/37.3± 12）, P〈0.001]. （2）In AMI group, the HR variation triangle indices of anterior wall were lower than inferior wall [ （23.5 ± 3.65 ） / （27.2 ± 7.85 ）, P 〈 0.05 ] ; and extensive anterior wall were lower than extensive inferior wall [ （ 22.4 ± 6.1 ） / （ 28.5 ± 8.5 ）, P 〈 0.01 ] . （3） In OMI group, the HR variation trian- gleindices of muhifoci myocardial infarction were lower than that of unifocus myocardial infarction [ （23.01 ± 73.05） / （27.4 ± 8.1 ）, P 〈 0.05]. （4）The HR variation triangle indices of 32 patients complicated with heart failure were obviously lower than 68 patients with myocardial infarction without complications [ （18.8 ± 6.25） / （30.0 ± 7.0）, P 〈 0.001 ]. （5）The HR variation triangle indices of 48 cases complicated with ventriculiar arrhythmia were lower than 38 myocardial infarction cases without complications [ （24.58±6.05） / （29.88± 7.1）, P〈0.001]. （6）According to the normal standard of HR various triangle index〉 25, the constitutional ratio which poor prognostic incidence and sudden death rate of HR variation triangle index in 〉 25 are as 8.8 times （24/90：4/132） and 8.1 times （11/90：2/132） as ≤25. According to the lowering degree of HR variation triangle index, we formulate the four grade standard： ≤25 mild abnormality; ≤20 moderate abnormality; ≤ 15 serious abnormality; ≤10 extreme abnormality. Conclusion： And it suggest that the vegetative nerve of angina pectoris and MI patients are severely damaged, consecutive ventriculiar tachycardia; ventricular fibrillation attack and sudden death are susceptible to occur.