老年男性高血压心肌肥厚患者血清总睾酮水平与交感神经兴奋性的关系

Relationship between the changes of serum total testosterone and sympathetic nerve activity in elderly hypertensive males with cardiac hypertrophy

目的探讨老年男性高血压心肌肥厚患者血清总睾酮水平与交感神经兴奋性的关系。方法入选老年男性高血压患者共80例,年龄60～90岁。采用24h动态心电图和心率变异性分析系统行心率变异性时域与频域分析。结果反映交感和迷走神经总的张力大小的时域指标24h内正常窦性心率R-R间期值的标准差(SDNN),在高血压心肌肥厚患者较高血压无心肌肥厚患者明显下降;反映交感神经张力的时域指标24h内连续每5分钟正常R-R间期平均值的标准差(SDANN)与24h内连续每5分钟正常R-R间期标准差的平均值(SDANN index),在高血压心肌肥厚组较高血压无心肌肥厚组明显下降;而反映交感神经张力的低频成分的归一化值(LFnu)与LFnu/高频成分的归一化值(HFnu)频域指标明显升高(均P<0.05)。血清总睾酮水平明显降低[(2.8±0.3)比(5.0±0.2)nmol/L,P<0.05]。血清总睾酮水平与交感神经兴奋性密切相关(均P<0.05),是后者独立危险因素。结论老年男性高血压心肌肥厚患者存在交感神经相对亢进和血清总睾酮水平降低,并且两者间变化密切相关。

Objective To investigate the relationship between serum total testosterone and sympathetic nerve activity in the elderly hypertensive males with myocardial hypertrophy.Methods A total of 80elderly hypertensive males aged from 60to 90year old were recruited.Heart rate variability was monitored with heart function information indicator.Results The parameters reflecting the total activities of sympathetic nerve and vagus nerve：standard deviation of NN intervals（SDNN）reduced significantly in elderly hypertensive males with myocardial hypertrophy compared to the ones without myocardial hypertrophy.The parameters reflecting sympathetic nerve activity：standard deviation of average normal-to-normal interval（SDANN）and SDANN index also reduced significantly in the same patient population.Other parameters reflecting sympathetic nerve activity：low-frequency normalized units（LFnu）and LFnu/HFnu increased significantly in elderly hypertensive males with myocardial hypertrophy compared to the ones without myocardial hypertrophy（all P0.05）.The serum testosterone level decreased in patients with hypertension and myocardial hypertrophy compared to patients with hypertension but without cardiac hypertrophy[（2.8±0.3）vs（5.0±0.2）nmol/L,P0.05].The serum testosterone was related to sympathetic nerve activity in elderly hypertensive males with myocardial hypertrophy.Conclusions Relative higher sympathetic nerve activity and significant reduction in serum total testosterone level were detected in the elderly hypertensive males with cardiac hypertrophy,and these two changes are closely related.