窦性心率震荡在不稳定型心绞痛患者危险分层中的作用

Role of sinus heart rate turbulence in risk stratification of patients with unstable angina pectoris

目的:评价窦性心率震荡指标在不稳定型心绞痛(UAP)的患者危险分层中的作用。方法:对63例确诊为UAP的患者(UAP组)和49例健康体检者(健康对照组)行24h动态心电图检查,比较其窦性心率震荡(HRT)指标;根据GRACE评分UAP患者被进一步分为UAP低危组、中危组、高危组,比较各分组间HRT指标的差异和HRT异常的发生率。结果:UAP组震荡初始(TO)明显高于健康对照组[(1.30±1.53)%∶(0.08±1.79)%,P<0.01];震荡斜率(TS)明显低于健康对照组[(1.90±0.56)∶(4.22±3.77),P=0.001]。UAP组不同危险分层亚组中,与低危组比较,中危组有TO增大、TS减小的趋势,但差异无显著性。高危组TO则显著增大[(0.55±1.61)%∶(2.05±1.21)%,P<0.01]、TS显著减小[(2.20±0.59)∶(1.71±0.44),P<0.01]。与低危组比较,中危组HRT2异常率有升高的趋势,差异无显著性(x2=2.385,P=0.063),高危组HRT2异常率显著升高(x2=9.227,P=0.01)。结论:结果提示窦性心率震荡指标可作为不稳定型心绞痛高危分层的一项新的心电学筛选指标。

Objective：To evaluate role of sinus heart rate turbulence（HRT） in risk stratification of patients with unstable angina pectoris（UAP）.Methods：A total of 63 patients with UAP and 49 healthy controls were enrolled in the study.They were measured with 24h dynamic electrocardiogram and indicators of sinus HRT of them were compared.According to GRACE scoring,the UAP patients were further divided into UAP low-risk group,medium-risk group and high-risk group.Then the difference of indexes of HRT and occurrence rates of abnormal HRT among the three groups were compared.Results：Turbulence onset（TO） of UAP group was significantly higher than that of healthy control group [（1.30±1.53）% vs.（0.08±1.79）%,P0.01];turbulence slope（TS） was significantly lower than that of healthy control group [（1.90±0.56） vs.（4.22±3.77）,P=0.001].Among subgroups of different risk stratification of UAP group,compared with low-risk group,medium-risk group had a trend of increasing TO and decreasing TS,but it had no significant difference.Compared with low-risk group,TO significantly increased [（2.05±1.21）% vs.（0.55±1.61）%,P0.01] and TS significantly decreased [（1.71±0.44） vs.（2.20±0.59）,P0.01] in high-risk group.Compared with low-risk group,occurrence rate of abnormal HRT2 was no significant difference in medium-risk group,（x2=2.385,P=0.063）;but it significantly increased in high-risk group（x2=9.227,P=0.01）.Conclusion：Results suggest that sinus heart rate turbulence could be used as a new electrocardiogram screening index for risk stratification in patients with unstable angina pectoris.