24h动态心电图评价冠心病患者心率变异性及其与冠状动脉病变严重程度的关系

Evaluation of heart rate variability in patients with coronary heart disease and its relation with the severity of coronary artery lesions by 24 h ambulatory electrocardiogram

目的应用24h动态心电图（AECG）评价冠心病患者心率变异性（HRV），同时探讨其各指标与冠状动脉病变严重程度的相关性。方法对118例冠心病患者根据冠脉造影（CAG）结果进行Gensini评分，根据积分分为三组，其中轻度病变组38例，中度病变组44例，重度病变组36例，分别应用AECG对上述三组及48例正常人进行HRV检测，分析其总体标准差（SDNN）、均值标准差（SDANN）、差值均方平方根（RMSSD）及爱丁堡指数（PNN50）等时域指标，以及低频（LF）、高频（HF）、低／高比率（LF／HF）等频域指标，分析比较相关差异，并用HRV各测值与Gensini积分进行相关性分析。结果HRV中的SDNN、SDANN、RMSSD、PNN50、低频（LF）、高频（HF）、低／高比率（LF／HF）指标在四组间比较差异均有统计学意义（P〈0．01），HRV指标中SDNN、SDANN、RMSSD、PNN50、高频（I-IV）、与Gensi—ni积分成负相关，低频（LF）呈正相关，低／高比率（LF／HF）无相关性。结论冠心病患者的自主神经调节功能受到损害，并随着冠脉病变程度的加重而加重，AECG可有效评价冠心病自主神经功能损害及其严重程度。

Objective To evaluate heart rate variability （HRV） in patients with coronary heart disease by applying 24 h ambulatory electrocardiogram （ AECG）, and investigate the various index corre-lation with the severity of coronary artery lesions. Methods The 118 patients with coronary heart disease （CHD） according to the result of coronary angiography （the CAG） Gensini score were divided into 3 groups, including 38 cases in mild lesion group, 44 cases in moderate lesion group, 36 cases in severe lesion group, respectively. AECG was applied to the above three groups and 48 normal people to detect the HRV, the overall standard deviation （SDNN）, the mean standard deviation （SDANN）, the differ-ence between the mean square root （RMSSD） and index （PNN50） time-domain indexes such as Edin-burgh, and low frequency （LF）, high frequency （HF） and low/high ratio （LF/HF） frequency domain index, such as variations associated with comparative analysis, and HRV in various measured values and Gensini score for correlation analysis. Results HRV in SDNN, SDANN, RMSSD, PNN50, low-fre-quency （LF）, high frequency （HF） and low/high ratio between indexes in the 4 groups （LF/HF）, comparative differences had statistical significance （ P 〈 0. 01 ）, index of HRV in SDNN, SDANN and RMSSD, PNN50, high frequency （HF）, a negative correlation with the Gensini score, low frequency （LF） were positively correlated, the low/high ratio （LF/HF） with no correlation. Conclusions In pa-tients with coronary heart disease, autonomic nervous adjustment function is damaged, and aggravated with the severity of coronary artery disease, AECG can effectively evaluate the autonomic nervous dys-function and the severity of coronary heart disease.