甲状腺功能异常患者心率变异性临床分析

Clinical analysis of heart rate variability in patients with thyroid disfunction

目的 分析甲状腺功能亢进症（简称甲亢）和甲状腺功能减退症（简称甲减）患者心率变异性,探讨两种疾病的自主神经功能状况.方法以哈尔滨市第二医院和哈尔滨医科大学第二临床医学院就诊的66例甲状腺疾病患者作为观察对象,分为甲亢组（36例）、甲减组（30例）,同时选取26例健康体检人员作对照组,进行12导联同步24 h动态监测,指标包括24 h连续窦性R-R间期标准差（SDNN）,24 h连续5 min节段的窦性R-R间期标准差（SDANN）,24 h内两个相邻窦性R-R间期差＞50 ms心率数占所分析信息期内的心率数的百分比（PNN50）,24 h连续窦性R-R间期差值的均方根（rMSSD）,低频段功率（LF）,高频段功率（HF）,低频段功率与高频段功率比值（LF/HF）.结果甲亢组心率变异性检测指标SDNN[（80.48±11.95）ms]、PNN50[（18.56±3.50）%]、rMSSD[（13.56±3.45）ms]均明显低于对照组[（128.06±12.8）ms、（32.84±7.21）%、（30.84±6.12）ms,P均＜0.05];LF/HF比值（3.78±1.63）与对照组（2.34±1.06）比较,明显增加（P＜0.05）.甲减组SDNN[（65.65±15.55）ms]、SDANN[（80.2±15.72）ms]、PNN50[（16.34±3.56）%]、rMSSD[（15.77±3.58）ms]、LF[（279.03±91.49）ms2/Hz]也明显低于对照组[（128.06±12.87）ms、（132.40±21.95）ms、（32.84±7.21）%、（30.84±6.12）ms、（525.60±84.11）ms2/Hz],两组比较差异有统计学意义（P均＜0.05）;LF/HF比值（1.08±0.73）与对照组比较,呈降低趋势,但差异无统计学意义（P＞0.05）.结论甲状腺功能异常患者心率变异性总体表现为降低,甲亢患者以交感神经活性占优势,而甲减患者以迷走神经活性占优势.

Objective To investigate the autonomic nervous system function of hyperthyroidism and hyperthyroidism by analyzing the heart rate variability of patients with the diseases. Methods 12-synchronous dynamic 24-hour monitoring and man-machine dialogue were used in 36 patients with hyperthyroidism, 30 patients with hypothyroidism and 26 cases of healthy volunteers（controls）, and 24-hour electrocardiogram was analyzed.Heart rate variability indicators observed included 24 h consecutive sinus standard deviation of R-R interval （SDNN）, standard deviation of sequential five-minute R-R interval （SDANN）, percentage of differences between adjacent NN intervals that 〉 50 ms（PNN50）, root mean square standard deviation from adjacent R-R interval （rMSSD）, low-frequency power （LF）, high frequency power （HF）, low frequency power/high frequency power （LF/HF）. Results In hyperthyroidism group, SDNN[（80.48 ± 11.95）ms], PNN50[（18.56 ± 3.50）%], rMSSD [ （ 13.56 ± 3.45）ms] were significantly lower than those of the control group[ （ 128.06 ± 12.8）ms, （32.84 ± 7.21）%,（30.84 ± 6.12）ms, all P 〈 0.05 ], and LF/HF（3.78 ± 1.63） were significantly higher than that of the control group （2.34 ± 1.06, P 〈 0.05）. In hypothyroidism group, SDNN[（65.65 ± 15.55）ms], SDAN[ （80.2 ± 15.72）ms],PNN50[ （16.34 ± 3.56）%], rMSSD [ （15.77 ± 3.58）ms ], LF[ （279.03 ± 91.49）ms2/Hz ] were also significantly lower than those of the control group[ （128.06 ± 12.87）ms, （132.40 ± 21.95 ）ms, （32.84 ± 7.21 ）%, （30.84 ± 6.12）ms, （525.60 ± 84.11）ms2/Hz, all P 〈 0.05], but LF/HF （1.08 ± 0.73） was lower than that of the control group,however, the difference was not significant（P 〉 0.05）. Conclusions The heart rate in patients with abnormal thyroid function is lower in the overall performance, but in patients with hyperthyroidism sympathetic activity is dominate, while in patients with hypothyroidism, vagal nerve activity is dominate.