冠心病患者心率变异与短暂性心肌缺血的关系

Relationship Between Heart Rate Variability and Transient Myocardial Ischemia Attacks in the Patients With Coronary Artery Disease

观察冠心病患者心率变异（HRV）与短暂住心肌缺血发作（TMIA）的关系以及药物对其的影响。应用动态心电图观察了50例健康人和50例过心病患者的24hHRV，特别是TMIA时及TMIA前的HRV，以及冠心病患者分别服用硫氮酮和硝苯地平控释片后HRV的变化。根据冠心病患者每阵TMIA的心肌缺血阈（IT）高于或低于IT均值，将TMIA分为高IT和低IT。结果表明：冠心病高IT的TMIA之前，HRV频域指标中的总功率谱面积（TP）、低频成分（LF）均增高（4．89±0.49vs5.53±1．39，P＜0．01；1．92±0．41vs2．42±0．55，P＜0．001），高频成分（HF）无明显变化，LF／HF比值升高（P＜0．01）。低IT的TMIA之前，TP、HF、标准化单位的HF（HFn）及LF均较低（4．76±0．72vs4．12±0．61，P＜0．001；0．63±0．14vs0.53±0.11，P＜0．001；24．01±5．63vs21．41±4．98，P＜0．05；1．88±0．40vs1．73±0．30，P＜0．05），标准化单位的LF（LFn）略增高（72．76±13．01vs75．34±14．06，P＞0.05），LF／HF比值升高（P＜0.001）。冠心病患者服用硫氮酮后，TP、HFn、LFn24h波动幅度及各时段测值均较用药前显著改善（P均＜0．001），服用硝苯地平控释片后则无相应变化。结论：心服自主神经功能异常与冠心病TMIA关系密切。

The aim of the study is to investigate the relationship between heart rate variability (HRV) and transient myocardial ischemia attacks (TMIA) in paients with coronary artery disease (CAD). 24-hour HRV in healthy subjects (50 cases ) and TMIA, 24-hour HRV,HRV before TMIA in patients with CAD (50 cases ) were observed.HRV in the patients after treatment with diltiazem or long term nifedipine was also observed. In the patients,the total power spectral area (TP ) and low frequency component (I,F ) elevated (4.89± 0. 94 vs 5. 53 ±1. 39, P＜0. 01; 1.92 ±0. 41 vs 2. 42±0.55, P＜0. 001), High frequency component (HF) didn't change and LF/HF ratio increased before high 1T,TMIA (H). The TP,HF,High frequency component in normalized unit (HFn) and LF decreased (4. 76±0. 72 vs 4. 12±0. 61,P＜0. 001 0. 63± 0. 14 vs 0. 53±0. 1l,P＜0. 001; 24. 01±5. 63 vs 21. 41±4 .98, P＜0. 05 ; 1. 88±0. 40 vs 1. 73±0. 30, P＜0.05), low frequency component in normalized unit (LFn) somewhat elevated (72. 76±13. 01 vs 75. 34±14. 06, P＞0. 05 ) and the LF/HF ratio increased before low IT,TMlA (L) in patients with CAD. 24 hour fluctuation and measurements of TP,HFn,LFn in the patient with CAD after diltiazem administration significantly improved. On the other hand,all these indices didn't show significant changes after long term nifedipine administration. lmpaired cardiac autonomic nervous function had close relation to TMIA.