杓型与非杓型高血压患者自主神经功能紊乱的比较

Comparison of dysfunction of autonomic nervous system in dipper and non-dipper type hypertension patients

目的 研究杓型与非杓型高血压患者自主神经功能紊乱的异同。方法 采用动态血压和动态心电图同步监测法 ,观察 86例高血压患者的血压昼夜变异曲线 ,依据昼夜不同时段 (上午 8∶0 0 ,下午 16∶0 0 ,子夜 0∶0 0 )的心率变异性指标 ,研究杓型、非杓型两组自主神经功能紊乱的异同 ,并与健康对照组比较。结果 血压昼夜变异曲线 6 2例(72 1% )呈杓型 ,2 4例 (2 7 9% )呈非杓型。与健康对照组相比 ,杓型组和非杓型组心率变异性分析的交感性指标增大 ,副交感性指标减小 ,LF/HF比值升高 (P <0 0 5或 0 0 1)。健康对照组在子夜时交感性指标最低 ,副交感性指标最高 ;杓型组具有此特点 ,而非杓型组不具有此种自主神经昼夜变化特点。杓型组子夜的LF/HF比值极显著小于白天 (P <0 0 1) ,而非杓型组三时段的LF/HF比值无显著性差异 (P >0 .0 5 )。非杓型组 3时段的LF/HF比值均极显著大于杓型组 (P <0 0 0 1)。结论 非杓型组自主神经功能紊乱较杓型组更重 ,已失去“子夜LF/HF比值小于白天”

Objective: To investigate the difference of dysfunction of autonomic nervous system in dipper and non dipper type hypertension patients.Methods: We synchronously applied ambulatory blood pressure monitoring and heart rate variability analysis in 86 essential hypertension patients,and researched into the difference of dysfunction of autonomic nervous system regarding the data of HRV in different periods(8∶00 in the morning,16∶00 in the afternoon,0∶00 at midnight.)Results: 62 cases (72 1%)showed dipper type of circadian blood pressure curve, and 24 cases(27 9%)showed non dipper type. Compared with the control group, sympathetic indictors in HRV of hypertension patients were increased, parasympathetic indictors were decreased and LF/HF ratio was elevated(P<0 05 or 0 01). Sympathetic indictors were lowest and parasympathetic indictors highest at midnight in both the dipper group and the control group,while the non dipper did not possess such a circadian rhythm. LF/HF ratios in non dipper group were significantly higher than those in the dipper group(P<0 001). LF/HF ratio in dipper group was significantly lower at midnight than that in the day, while LF/HF ratio in 3 various periods did not show to be significantly different in the non dipper group.Conclusion:Dysfunction of autonomic nervous system in non dipper group is more serious than that in dipper group.