腹膜透析患者血压状态与心率变异性关系的横断面研究

Cross-sectional study of relation between blood pressure and heart rate variability in patients with peritoneal dialysis

目的:探讨腹膜透析患者血压状态与心率变异性的关系。方法:采取横断面研究,选取2010年5月至9月就诊于北京大学第三医院腹膜透析门诊的患者,根据血压状态,把患者分为低血压组、正常血压组、高血压组3组,检测5 min短时程频域分析的有关心率变异性,并收集患者的一般资料、容量指标、临床生化指标以及透析充分性指标。结果:各组心率变异性的时域及频域分析显示,高血压组心率变异性中时域指标[正常RR间期的标准差(SDNN)、连续RR间期差值的均方根(rMSSD)、全程相邻RR间期长度之差的标准差(SDSD)、相邻正常RR间期差值>50 ms的心搏数占总RR间期数的百分比(PNN50)]及频域指标[低频段(LF)、高频段(HF)]较正常血压组均降低,而LF/HF则升高。低血压组SDNN、rMSSD、SDSD、PNN50及频域指标LF、HF均升高,而LF/HF则降低,差异均具有统计学意义。单因素相关分析显示收缩压及舒张压均与SDNN(r=-0.386,P<0.001;r=-0.399,P<0.001)、rMSSD(r=-0.373,P<0.001;r=-0.426,P<0.001)、SDSD(r=-0.375,P<0.001;r=-0.425,P<0.001)、PNN50(r=-0.223,P=0.032;r=-0.245,P=0.018)、TP(r=-0.328,P=0.001;r=-0.312,P=0.002)、LF(r=-0.260,P=0.012;r=-0.194,P=0.063)、HF(r=-0.394,P<0.001;r=-0.365,P<0.001)呈负相关,与LF/HF呈正相关(r=0.275,P=0.008;r=0.171,P=0.1)。多元回归分析显示,经过调节多种因素后,自主神经功能仍然是影响收缩压和舒张压的独立因素。结论:腹膜透析患者中,低血压、正常血压、高血压患者之间心率变异性存在差异。低血压组主要表现为副交感兴奋,交感抑制;高血压组主要表现为交感过度兴奋,自主神经受损。自主神经功能是影响腹膜透析患者血压状态的独立因素。

Objective：To analyze the possible relationship between heart rate variability（HRV） and blood pressure in peritoneal dialysis patients.Methods： In this cross-sectional study,93 continuous ambulatory peritoneal dialysis patients（CAPD） patients were enrolled.Patients were divided into three groups according blood pressure.HRV which reflects autonomic nerve function（ANF） were measured by using 5-minutes recordings of a stationary system by a standardized method.Both time-domain and frequency domain parameters were analyzed.Results： HRV time domain indices [the standard deviation of all normal RR intervals（SDNN）,the square root of the mean of the squared differences between adjacent normal RR intervals（rMSSD）,the standard deviation of differences between adjacent NN intervals（SDSD）,the percentage of differences between adjacent normal RR intervals that were 50 ms computed（PNN50）] and frequency domain indices [the low-frequency energy in the power spectrum 0.04-0.15 Hz（LF）,the high-frequency energy in the power spectrum 0.15-0.4 Hz（HF）] were significantly lowest in hypertensive group（P0.05） whereas LF/HF was highest as compared to normal BP group（P0.05）.Univariable correlation analysis showed that both systolic and diastolic blood pressure were negatively correlated with SDNN（r=-0.386,P0.001;r=-0.399,P0.001）,rMSSD（r=-0.373,P0.001;r=-0.426,P0.001）,SDSD（r=-0.375,P0.001;r=-0.425,P0.001）,PNN50（r=-0.223,P=0.032;r=-0.245,P=0.018）,TP（r=-0.328,P=0.001;r=-0.312,P=0.002）,LF（r=-0.260,P= 0.012;r=-0.194,P=0.063）,HF（r=-0.394,P0.001;r=-0.365,P0.001）,and positively correlated with LF/HF（r=0.275,P=0.008;r=0.171,P=0.1）.Multivariable regression analysis showed that HRV indicators were independently factor affecting both systolic and diastolic blood pressure in PD patients.Conclusion： ANF assessed by HRV were significantly different in PD patients with blood status,parasympathetic nerve were activated in hypotension group whereas sympathetic nerve were activated in hypertension group.ANF was independently factors associated with blood pressure.