自主神经功能指标对心脏性猝死的预测价值

Predictive Values of Autonomic Nerve Function Indexes in Sudden Cardiac Death

目的探讨自主神经功能指标(心率变异性及心率震荡)对心脏性猝死(SCD)患者的预测价值。方法对江西省人民医院门诊及住院的50例猝死高危患者(猝死高危组)进行前瞻性随访研究,同时选择无明显器质性心脏病史的患者50例作为对照组。2组患者均采用24 h动态心电图进行检测,分析心率变异性的24 h正常窦性RR间期的标准差时域指标(SDNN)、窦性心率震荡的心率起始(TO)和心率斜率(TS)指标的变化,3个月随访1次,持续2年。猝死高危组根据是否发生终点事件分为恶性心律失常组(12例)及非恶性心律失常组(38例)。以SCD或室颤作为终点事件,对上述数据进行统计学分析。结果猝死高危组中12例患者发生SCD(冠心病6例,扩张性心脏病5例,长QT综合征1例)。猝死高危组SDNN、TS均明显低于对照组,TO高于对照组(均P<0.05)。恶性心律失常组的TS明显低于非恶性心律失常组(P<0.05);2组SDNN及TO比较差异均无统计学意义(均P>0.05)。结论猝死高危患者TS低于对照组,且与恶性心律失常的发生关系密切。TS可能是SCD预测的重要指标。

Objective To explore the predictive values of autonomic nerve function indexes （heart rate variability and heart rate turbulence） in sudden cardiac death （SCD）. Methods A prospective follow-up study was performed in 50 outpatients and inpatients at high risk of sudden death （high risk of sudden death group） in Jiangxi provincial people＇s hospital. In addition, 50 patients without obvious organic heart disease were chosen as control group. The 24-hour electrocardiographic monitoring was performed to analyze standard deviation of normal-to-normal RR intervals （SDNN）, turbulence onset （TO）and turbulence slope （TS）. Patients were followed up once three months for 2 year. According to whether end point events occurred, the 50 patients at high risk of sudden death were further divided into malignant arrhythmia group （n=12） and non-malignant arrhythmia group （n=38）. The association of arrhythmia with SCD or ventricular fibrillation was studied using logistic analysis. Results In high risk of sudden death group, 12 patients had SCD, including 6 cases of coronary heart disease, 5 cases of dilated cardiomyopathy and 1 case of long QT syndrome. Compared with control group, SDNN and TS decreased but TO increased in high risk of sudden death group （P〈0.05）.Compared with non-malignant arrhythmia group, TS decreased in malignant arrhythmia group （P〈0.05）. No significant differences in SDNN and TO were found between non-malignant arrhythmia group and malignant arrhythmia group （P〉0.05）. Conclusion The TS in patients at high risk of sudden death is lower than that in patients without organic heart disease, and is closely related to the occurrence of malignant arrhythmia. Therefore, TS may be an important predictor of SCD.