心率震荡影响急性冠脉综合征预后的临床研究

The clinical value of heart rate turbulence in prognosis of patients with acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者心率震荡(HRT)的变化及对患者预后的评价。方法选择2008年10月至2009年9月在天津市胸科医院住院的170例确诊为ACS患者(ACS组),同期50例正常者为对照组。所有入选者均在入院后行24 h动态心电图检查,分析和测量HRT的参数:震荡初始(TO)和震荡斜率(TS),并同时记录临床信息、左室射血分数(LVEF)。同时对ACS患者平均随访(20.5±12.2)个月,根据随访中是否发生心血管不良事件(MACE)将ACS患者分为MACE事件组和非MACE事件组。结果与对照组比较ACS组的TO显著增高(P<0.01),而TS则显著降低(P<0.01);MACE事件组与非MACE事件组比较TO显著增高(P<0.01),TS显著降低(P<0.01);Logistic回归分析显示TO、TS、LVEF对患者预后的预测作用最好。Pearson相关分析显示LVEF与TO呈负相关(r=-0.165,P=0.016),与TS呈正相关(r=0.172,P=0.012);HDL-C与TO呈负相关(r=-0.171,P=0.012),与TS呈正相关(r=0.235,P=0.001)。结论ACS患者的HRT明显减弱,迷走神经调节功能下降;HRT在评价患者预后中具有良好的临床参考价值。HRT与HDL-C的相关性不仅表明HRT能够反映HDL-C的水平,同时进一步证实HRT在评价患者预后中的价值。

Objective To observe the effects of altered heart rate turbulence （HRT） on prognosis of patients with acute coronary syndrome （ACS）. Methods 170 patients confirmed with ACS （ACS group were selected,with 50 normal people as controls （ control group）. All the subjects were performed 24-hour Holter examination after hospitalization and determined the parameters of HRT： turbulence onset （TO） and turbulence slope （TS）. Moreover, the clinical information, left ventricu- lar ejection fraction （LVEF） were recorded. Meanwhile, the ACS patients were followed up for （ mean： 20. 5 ± 12. 2 ） months and classified into MACE and non-MACE groups according to the presence of MACE. Results On one hand,ACS group had a significant increase in TO （P 〈 0.01 ） but decrease in TS （P 〈 0. 01 ） as compared with control group. On the other hand,MACE group had a significant increase in TO （P 〈0. 01 ） but decrease in TS （P 〈0. 01 ） as compared with non-MACE group. The Logistic regression analysis showed that TO,TS and LVEF had the best predicting effects on progno- sis of patients. And Pearson correlation analysis demonstrated that LVEF was negatively associated with TO （ r = - 0. 165, P = 0. 016） but positively with TS （ r = 0. 172,P - 0- 012） ; HDL-C had a negatiye correlation with TO （ r = - 0. 171, P = 0. 012） but a positive correlation with TS （r =0. 235 ,P =0. 001）. Conclusion HRT was significantly weakened in ACS patients, and the regulatory functions of vagal nerve were decreased as well. HRT might have a favorable clinical reference value in evaluating prognosis of patients. The correlation of HRT and HDL-C not only proved that HRT could reflect the HDL-C level, but further confirmed the value of HRT in evaluating prognosis of patients.