老年高血压左室肥厚心率变异性和血压变异性与胰岛素抵抗的关系

The relationship between heart rate variability,blood pressure variability and insulin resistance in geriatric patients with essential hypertension with left ventricular hypertrophy

目的:探讨老年原发性高血压病(EH)左室肥厚(LVH)患者的心率变异性(HRV)和血压变异性(BPV)变化与胰岛素抵抗(IR)的关系。方法:对236例老年EH患者,应用其身高、体重和超声心动图测量结果计算出其左室重量指数(LVMI),根据LVMI结果分为87例LVH组和149例非LVH组。对87例EH合并LVH患者、149例EH非LVH患者和112例对照组的HRV、BPV和糖代谢参数进行比较分析。结果:与对照组比较,EH非LVH组SDNN(P<0.01)、SADNN(P<0.05)、HF(P<0.05)、IRI(P<0.01)、FPI(P<0.05)、P2hG(P<0.05)和P2hI(P<0.01)显著下降,LF(P<0.05)和LF/HF(P<0.05)显著增加。与EH非LVH组比较,EH合并LVH组SDNN(P<0.01)、SADNN(P<0.01)、PNN50(P<0.05)和HF(P<0.05)显著下降,LF/HF(P<0.01)、24hSSD(P<0.05)、dSSD(P<0.05)、IRI(P<0.01)、FPG(P<0.05)、FPI(P<0.05)、P2hG(P<0.05)和P2hI(P<0.01)显著增加。结论:老年EH合并LVH患者存在着HRV、BPV和糖代谢功能异常,IR可加重EH合并LVH患者的HRV和BPV的异常程度。

Objective：To observe the changes of heart rate variability （HRV）, blood pressure variability （BPV） and insulin resistance（IR） and to investigate the relationship between HRV, BPV and IR in geriatric patients of essential hypertension （EH） with left ventricular hypertrophy （LVH）. Methods： Left ventricular mass indexes （LVMI） of 236 patients with EH were calculated their height,body weight and echocardiography , and all patients were divided into LVH group and non - LVH group according to LVMI. The parameters of HRV, BPV and IR were compared in 87 cases of EH with LVH, 149 cases of EH without LVH and 112 control subjects. Results ：SDNN（P〈0. 01） ,SADNN（P〈0.05） ,HF（P〈0.05） ,IRI（P〈0. 01） ,FPI（P 〈0. 05）,P2hG（P〈0. 05） and P2hI（P〈0. 01） of EH group without LVH were significantly lower and LF（P〈 0. 05） and LF/HF（P〈0. 05） were significantly higher than those in control group respectively. SDNN（P〈0. 01） ,SADNN（P〈0. 01）,PNN50（P〈0. 05） and HF（P〈0. 05）of EH ＋ LVH group were significantly lower and LF/HF （P〈0. 01 ）, 24hSSD（P〈0. 05） ,dSSD（P〈0. 05） ,IRI （P〈0. 01 ） ,FPG （P〈0. 05） ,FPI （P〈0. 05） ,P2hG （P〈0.05）and P2h1 （P〈0. 01） was significantly higher than those in EH group respectively. Conclusion： The HRV, BPV and glycometabolism are abnormal in geriatric cases of EH with LVH, and HRV and BPV can be made serious by IR.