冠状动脉病变与心率变异性的关系

The relationship between coronary artery lesion and heart rate variability

目的探讨心率变异性(HRV)在评估冠心病病情中的意义。方法136例患者经冠状动脉造影按病变程度分为完全阻塞组31例,部分阻塞组53例,非阻塞组52例。84例阻塞病例再按病变部位、累及病变支数分亚组。通过24h动态心电图检查计算HRV的时域指标:R-R总体标准差(SDNN)、24h每5min时段平均R-R间期标准差(SDANNind)、每5min时段R-R间期标准差的24h平均值(SDNNind)、相邻R-R间期差值的均方根(rMSSD)、相邻R-R间期差值50ms的百分数(PNN50)。分析不同冠状动脉病变之间HRV的差异。结果(1)冠状动脉狭窄程度越重,SDNN、SDANNind、SDNNind下降越明显,而rMSSD、PNN50降低不明显;(2)左冠状动脉病变SDNN、SDANNind明显下降,而右冠状动脉病变HRV各指标下降均无统计学意义(P>0.05);(3)冠状动脉病变支数越多,HRV各指标下降越明显,但只有3支病变组下降有统计学意义(P<0.05)。结论冠心病患者HRV下降越明显,提示冠状动脉狭窄程度越重、病变多在左冠状动脉、病变范围越广。对冠心病患者病情评估有一定意义。

Objective To investigate the significances of heart rate variability（HRV） in evaluation the state of coronary artery disease（CAD）. Methods Totally 136 cases were proved with CAD by corollary angiography, and all of them were classified with completely occlusion group （31 cases）, partly occlusion group （55 cases） and non occlusion group（52 cases）. Eighty-four cases with eoronary artery occlusion were divided into subgToup according to lesion position. The time domain indexes of HRV were calculated through 24 h dynamic electrocardiogram monitor, including standard deviation of normal number of intervals（ SDNN）, standard deviation of per 5min averages normal number of intervals（ SDANNind）, average of standard deviation of normal number of intervals（ SDNNind）, root means quarevalues of the standard deviation between adjacent normal number of intervals（ rMSSD）, and percentage of NN50 in the total number of NN intervals （PNN50）. The HRV differences between subgroups were compared. Results （ 1 ） It demonstrated that time-domain HRV（SDNN, SDANNind, SDNNind） were significantly descended when the coronary stenosis increasing, while other indexes including rMSSD, PNN50 were not obviously. （2）In CAD patients mainly involved left coronary artery, the HRV （SDNN, SDANNind） were significantly descended, while it＇s not significantly in patients involved right coronary artery （ P 〉 0.05 ）. （3） All time domains HRV （ SDNN, SDANNind, SDNNind, rMSSD, PNN50 ） tended to descend with the number of involved coronary artery. But only in patients with three branches involved were statistical significant（ P 〈 0.05）. Conclusion With tbe descending of HRV, the CAD was suggested severely, the extent of disease was widely, and more possible involved left coronary artery.