单纯收缩期高血压患者脉搏波传导速度与心率变异性

The Research of Pulse Wave Velocity and Heart Rate Variability in patients with Isolated Systolic Hypertension

目的研究单纯收缩期高血压患者主动脉脉搏波传导速度与心率变异性特别是低频部分(LF)的关系,评估这两个指标与心血管危险度的相关性。方法选取单纯收缩期高血压(ISH,n=89)患者及双期高血压(DH,n=98)患者,应用 SUN-8800动脉硬化检测仪检测颈股动脉脉搏波传导速度(cfPWV)及颈桡动脉脉搏波传导速度(crPWV),采用5 min 短程频域分析法分析其心率变异性(HRV)指数。89例 ISH 根据危险程度分为低危(n=3)、中危(n=17)、高危(n=35)以及极高危(n=34)4组,观察不同危险程度组间 cfPWV、crPWV 及 HRV 指数与心血管危险程度的相关性。结果 ISH 的 cfPWV 明最高于 DH[ISH:(399.6±48.2)cm/s 比 DH:(374.3±39.7)cm/s,P<0.01],而两组 crPWV 无明显差异[ISH:(371.5±37.5)比 DH:(363.5±31.5)cm/s,P>0.05];ISH 的心率变异指数、LF 以及 LF/HF 明显高于 DH[ISH:(3.28±0.86)log ms^2比 DH:(2.93±0.59)log ms^2,P<0.05]。cfPWV 与极低频功率(VLF)、LF 呈显著正相关(P<0.05)而与 TP、HF 呈显著负相关(P<0.05),crPWV与 VLF、LF、HF 及 TP 无明显相关性。ISH 患者总体心血管风险程度与 cfPWV 及 crPWV 均呈显著正相关(r=0.765、0.563,P<0.05),cfPWV 随风险程度增高而显著增加(P<0.05),crPWV 也随风险程度增高而增加,但差异无统计学意义(P>0.05);ISH 总体心血管风险程度与 LF 呈显著正相关(r=0.479),VLF、LF、LF/HF 随风险程度增高而显著增加(P<0.01),但 TP、HF 随风险程度增加而显著降低(P<0.01)。结论提示 ISH 病人只有 cfPWV加快,而 crPWV 与正常血压相同,cfPWV 加快为指标的主动脉僵硬度与 HRV 的交感神经兴奋性指标(LF)明显相关。

Objective To investigate the characteristics of pulse wave velocity（PWV） and heart rate variability （HRV} and evaluate their feasibility in grading the cardiovascular risk in patients with isolated systolic hypertension （ISH）. Methods Eighty-nine ISH patients and systolic-diastolic hypertension patients（DH, n= 98） admitted in our hospital were submitted carotid-radial PWV（crPWV）, carotid-femoral PWV（cfPWV） and HRV, ISH patients were categorized depending on their risk grade as： low risk group（n=3 ）, moderate risk group（n=17）, high risk group（n=35） and very high risk group（n=34）. Results The cfPWV in ISH patients is significantly higher than that of sys-diastolic hypertension group（ISH ： 399.6 ± 48.2 vs sys-diastolie hypertension： 374.3±39.7 cm/s, P〈0.01], with no difference in crPWV between them （ P〉0.05 ）. The LF in ISH group are markedly higher than those in DH （ISH： 4. 35±1.07 log mse vs 3.78±0.82 log ms2 , P〈0.05）. The cfPWV is positively related with the LF （r= 0. 549, P〈0. 05 ） while erPWV is not related with LF, cfPWV is markedly positive correlated with the degree of the total cardiovascular risk（rs = 0. 765, P〈0.05）, while crPWV is not significantly increased （P〉0.05）. LF are markedly positive correlated with the degree of the total cardiovascular risk（rs：0. 438,P〈0. 05）. Conclusion The cfPWV, LF are significantly increased, but not cfPWV in ISH patients, cfPWV and LF in HRV may serve as clinic indices to evaluate ISH cardiovascular risk and the effect of ISH treatment.