原发性高血压肾功能损害与心率变异性关系的探讨

Relations between the Damage of the Renal Functions and Heart Rate Variability in the Hypertensive Patients

目的:探讨心率变异性指标与原发性高血压患者肾功能损害的关系。方法:选择210例原发性高血压(EH)患者进行24小时动态心电图监测(Holter),分析HRV各相指标:SDNN[所有窦性心率R-R(NN)间期的标准差],SDANN(全程记录中每5分钟NN间期平均值的标准差),PNN50(全程记录中相邻NN间期差值>50ms的个数)和RMSSD(相邻NN间期差值的均方根)。同时测定肾功能指标血清肌酐(Scr),根据Scr分为EH肾功能正常组58例、肾功能不全代偿期61例、肾功能不全失代偿期37例、肾功能衰竭期33例、尿毒症期21例。结果:原发性高血压患者随着肾功能损害程度的加重,心率变异性的各项指标SDNN[所有窦性心率R-R(NN)间期的标准差]、SDANN(全程记录中每5分钟NN间期平均值的标准差)、PNN50(全程记录中相邻NN间期差值>50ms的个数)、RMSSD(相邻NN间期差值的均方根)均逐渐降低。相关性检验进一步证实原发性高血压患者SDNN、SDANN、PNN50、RMSSD与血肌酐呈负相关。结论:原发性高血压患者随着肾功能的减退,心率变异性下降,自主神经调节功能下降。

Objective： To evaluate the relations between the damage of the renal functions and the heart rate variability（HRV） in hypertensive patients（EH）.Methods： Heart rate variability was detected in 58 patients with normal renal functions,61 patients with compensatory renal functions,37 patients with decompensated renal functions,33 patients with renal failure and 21 patients with uraemia and the patients all had essential hypertension.The heart rate variability indices of SDNN,SDANN,PNN50,RMSSD were used.Results： SDNN,SDANN,PNN50 and RMSSD descended with the worsening damage of the renal functions in the patients.Regression analysis showed that Scr was negative correlation with SDNN,SDANN,PNN50 and RMSSD.Conclusion： The decrease of heart rate variability and the abnormality in the regulation function of autonomic nerves become more serious with the worsening damage of the renal functions in the hypertensive patients.