不稳定型心绞痛患者窦性心率震荡及其与冠状动脉病变程度的关系

Association between heart rate turbulence and the severity of the coronary arteries disease in patients with unstable angina pectoris

目的评价不稳定型心绞痛患者窦性心率震荡（HRT）指标变化及其与冠状动脉病变严重程度的关系。方法应用相应的分析软件对60例确诊为不稳定型心绞痛患者的24h动态心电图检查结果进行分析，并与40例健康体检者比较其HRT指标；对不稳定型心绞痛组冠状动脉病变支数、冠状动脉评分与HRT进一步进行线性回归分析，评价HRT与冠状动脉病变程度的关系。结果不稳定型心绞痛组震荡初始（TO）、动态心率震荡（TD）明显高于健康对照组[（1．18±1．23）％与（0．39±2．06）％；（-0．082±0．087）ms／（RRI·bpm）与（-0．148±0．104）ms／（RRI·bpm），P〈0．05]；震荡斜率（TS）明显低于健康对照组[（1．66±0．77）ms／（RRI·bpm）与（4．46±0．09）ms／（RRI·bpm），P〈0．001）。亚组分析中冠状动脉多支病变组较单支病变组髑减小（P〈0．05），TD增大（P〈0．05）；冠状动脉病变评分〉10分组TS显著变小[（1．46±0．84）ms／RRI·bpm与（1．97±0．49）ms／（RRI·bpm），P=0．01]，TD增大[（-0．059±0．053）ms／RRI·bpm与（-0．119±0．112）ms／（RRI·bpm），P〈0．01]；各亚组TO变化差异均无统计学意义（P均〉0．05）；冠状动脉病变与HRT指标线性回归分析，TS与冠状动脉病变支数负相关（r=-0．296，P〈O．05），与冠状动脉病变评分负相关（r=-0．372，P〈0．05）；TD与冠状动脉病变支数正相关（r=0．353，P〈0．01），与冠状动脉病变评分正相关（r=0．510，P〈0．05）。结论不稳定型心绞痛患者的心率震荡现象明显减弱，尤以TS和TD变化显著；并且与冠状动脉病变的严重程度有一定相关性。TD在测量时不受室性期前收缩前心率的影响，与TS联合检测可提供更客观的预测价值。

Objective To evaluate the association between parameters of heart rate turbulence （HRT） and the severity of the coronary arteries disease. Methods 60 patients with unstable angina peetoris （UAP） who underwent angiographic examination and 40 healthy controls were chosen. HRT including turbulence onset （TO） , turbulence slope （TS） and turbulence dynamicity （TD） were determined by 24 h ambulatory electrocardiogram（Hoher） in all the patients. The value of above indices were compared between UAP group and control group, and between subgroups of UAP. The correlation of HRT with the severity of coronary arteries diseases was analyzed. Results The levels of TO and TD in patients with UAP were significantly higher than those in controls [ （1.18 ± 0.88 ）% vs （0.39±2.06）% ; （ -0. 082±0. 087） ms/（RRI · BPM） vs （ -0. 148 ±0. 104） ms/（RRI · BPM）P 〈0.05], while TS was significantly lower than those of the controls [ （ 1.66± 0.77 ） ms/（ RRI · BPM） vs （4.46 ± 0.09） ms/（RRI · BPM）,P 〈 0. 001 ]. In subgroups of UAP,patients with coronary muhivessel lesions had significantly lower TS （ P 〈 0.05 ） and higher TD （ P 〈 0.05 ） than those in patients with coronary single vessel lesion. The same result can also be observed in patients with high coronary artery stenosis score[ （1.46 ±0.84）ms/（ RRI · BPM） vs （1.97±0.49）ms/（RRI· BPM） ,P=0.01;（ -0.059 ±0.053）ms/（RRI · BPM） vs （-0.119±0.112） ms/（RRI· BPM）,P〈 0.01 ]. TS was negtively correlated with the number of abnormal coronary artery （r = -0. 296 ,P 〈 0.05 ） and coronary artery stenosis score （r = -0. 372, P 〈 0.05 ） ;TD was positively correlated with number of abnormal coronary artery （ r = 0. 353, P 〈 0.01 ） and coronary artery stenosis score （ r = 0. 510, P 〈 0.05）. Conclusion HRT is impaired in patients with UAP, especially the changes of TS and TD is signficant,and is correlated with the severity of coronary arteries disease. TD is not influenced by premature ventricualr contraction heart rate so the combinatoin of TD and TS might be used as objective index in predicting the severity of the coronary arteries disease.