老年患者原发性高血压合并2型糖尿病心率震荡的变化及其临床价值研究

Clinical value and changes of heart rate turbulence in elderly patients with essential hypertension and type 2 diabetes mellitus

目的探讨老年原发性高血压合并2型糖尿病患者心率震荡的变化及其临床价值。方法选取海军钓鱼台干休所卫生所2009年1月～2012年1月收治的老年原发性高血压合并2型糖尿病患者75例为观察组,选取同期收治的老年原发性高血压患者75例为对照组。所有患者均行24 h动态心电图监测,采用美国Space Lab分析系统对患者震荡初始(TO)、震荡斜率起始时间(TT)、震荡斜率(TS)、动态心率震荡(TD)等心率震荡指标进行比较,分析心率震荡各指标与年龄、平均心率、心率变异性时域指标(SDNN)的相关性。结果观察组TO、TS、TD、SDNN均明显低于对照组,差异均有统计学意义(均P<0.05)。TO与年龄呈正相关(P<0.05),与TS、TD、SDNN呈负相关(P<0.05);TS与TD、SDNN呈正相关(P<0.05),与TO呈负相关(P<0.05);TD与TS、SDNN呈正相关(P<0.05),与TO、平均心率呈负相关(P<0.05)。结论老年原发性高血压合并2型糖尿病患者心率震荡指标明显减弱,患者的自主神经功能受损严重。心率震荡指标可以作为早期诊断高血压合并2型糖尿病患者心脏自主神经功能紊乱的有效可靠无创指标之一。

Objective To investigate the clinical value and changes of heart rate turbulence in elderly patients with essential hypertension and type 2 diabetes mellitus.Methods 75 elderly patients with essential hypertension and type 2 diabetes mellitus were selected in Navy Diaoyutai retired cadres health center from January 2009 to January 2012 as the observation group.75 elderly patients with essential hypertension were selected in our hospital at the same period as the control group.All patients were given 24 h dynamic electrocardiogram monitoring.The United States space lab analysis system was used to compare heart rate turbulence indexes of turbulence onset（TO）,turbulence timing（TT）,turbulence slope（TS） and turbulence dynamic（TD）.The correlation among heart rate turbulence indexes and age,average heart rate,standard deviation of the NN interval（SDNN） were analyzed.Results TO,TS,TD,SDNN in the observation group were alll significantly lower than those in the control group,the differences were all statistically significant（all P 0.05）.TO was positively correlated with age（P 0.05）,which was negatively correlated with TS,TD,SDNN（all P 0.05）.TS was positively correlated with TD,SDNN（P 0.05）,which was negatively correlated with TO（P 0.05）.TD was positively correlated with TS,SDNN（P 0.05）,which was negatively correlated with TO,mean heart rate（P 0.05）.Conclusion Heart rate turbulence indexes of elderly patients with essential hypertension and type 2 diabetes mellitus decreased significantly.Autonomic nervous function of patients is seriously damaged.Heart rate turbulence indexes can be used as effective,reliable and noninvasive indexes in early diagnosis of cardiac autonomic nerve function disorder in elderly patients with essential hypertension and type 2 diabetes mellitus.