心率变异性评价持续性房颤自主神经功能的价值

The applicability of heart rate variability for evaluating autonomic function of persistent atrial fibrillation

目的探讨持续性心房颤动(PAF)时心率变异性(HRV)评价自主神经功能(AUF)的价值。方法选取符合ACC/AHA(2006)中PAF诊断标准的PAF患者110例,患者在行12导联同步动态心电图检查当日晨6时左右采肘静脉血2管各4ml,采用ELISA法分别检测血清乙酰胆碱酯酶(AChE)和血浆去甲肾上腺素(NE)水平;检测采血前5min的HRV指标和平均心室率,并计算R-R间期标准差(SDNN)、相邻R-R间期差的均方根(rMSSD)、低频(LF)、高频(HF)及LF/HF比值,采用Pearson相关分析法分析SDNN、rMSSD、LF、HF、LF/HF比值和平均心室率与血浆NE和血清AchE水平间的相关性。结果血浆NE水平与SDNN、rMSSD、LF呈负相关(r值分别为-0.236、-0.224、-0.191,P均<0.05),与平均心室率呈正相关(r=0.408,P<0.01),而与HF及LF/HF无显著相关性(P>0.05);血清ACHE水平与SDNN、rMSSD、LF、HF、LF/HF及平均心室率均无显著相关性(P均>0.05)。结论 (1)PAF时HRV分析对AUF无直接评价作用;(2)PAF患者心室率部分受AUF调控。

Objective To identify whether HRV can be used to evaluate autonomic function in patients with PAF.Methods One hundred and ten patients with PAF were enrolled.The diagnosis of PAF was conformed to ACC/AHA 2006guidelines for the management of patients with atrial fibrillation executive summary.The paroxysmal AF was exclued.Venous blood sample was collected at 6am during 12-lead ambulatory ECG monitoring from every patient.Both plasma NE and serum ACHE were examined.The parameters of 5minutes HRV before time of collecting blood which include standard deviation of the R-R intervals（SDNN）,Root-mean-square of the successive differences of normal R-R intervals（rMSSD）,low frequency（LF）,high frequency（HF）and LF/HF were calculated and analyzed by 12-lead ambulatory ECG.Then Pearson correlation analysis was done between the parameters of HRV and the average ventricular rate and plasma NE and serum ACHE.Results Plasma NE and SDNN,RMSSD and LF were negatively correlated（r values were-0.236,-0.224,-0.191,P values were 0.013,0.019,0.046）.Correlationship was not found between plasma NE and HF and LF/HF（P0.05）.Plasma NE and the average ventricular rate was positively correlated（r=0.408,P= 0.000）.There is no correlationship between serum ACHE and SDNN,rMSSD,LF,HF,LF/HF and average ventricular rate（P0.05）.Conclusion The ventricular rate in patients with PAF is affected partly by autonomic function.This functional change can not be reflected directly by HRV.