维持性血液透析患者心率变异性对心源性死亡率的影响

The influence of heart rate variability on cardiac death in maintenance haemodialysis patients

目的评估心率变异性(heart rate variability,HRV)下降对终末期肾脏病维持性血液透析患者的临床意义及对心源性死亡率的影响。方法对64例维持性血液透析患者[年龄(58±15)岁,男性25例,透析时间(42±54)月]进行24h动态心电图描述并分析时域和频域HRV指标。结果参试患者与30例健康人群对照,HRV显著性减低。在2年随访期间中,共有13例患者死亡(20.3%);6例为心源性死亡、7例为非心源性死亡。Cox生存分析提示,在HRV检测指标中,窦性心搏间期标准差(SDNN)、超低频功率、RR间期心率变异比值(LF/HF)对于心源死亡有显著性指示意义。而对非心源死亡病例,HRV检测各指标均无显著性指示意义。结论 HRV指标水平降低,对于维持性血液透析患者的心源性死亡有显著性预测意义。

Objective The aim of this study was to evaluate the influence of decreased heart rate variability （HRV） on cardiac death in end-stage renal disease patients on maintenance hemodialysis （MHD）. Methods We studied 64 MHD patients （58 ± 15years old; 25 males） with the hemodialysis duration of 42 ± 54 months, All these patients underwent 24h electrocardiography for the analysis of time- and frequency-domain HRV. Results MHD patients were matched with 30 healthy subjects. HRV was significantly reduced in MHD patients. During a follow-up period of 2 years, 13 patients died （20.3%）, in which 6 died of cardiac causes and 7 of non-cardiac causes. Cox proportional hazards model revealed that standard deviation of normal-to-normal R-R intervals during 24h （SDNN）, very-low-frequency power （0.0033-0.04 Hz）, and the ratio of low-frequency to high-frequency power had significant predictive values for cardiac death but not for non-cardiac death. Conclusions The decrease of HRV parameters is predictive for cardiac death in hemodialysis patients.