慢性肾功能不全患者的心率变异性分析

Heart rate variability in patients with chronic renal insufficiency

目的 引入心率变异性 (HRV)分析的方法 ,评价慢性肾功能不全 (CRI)患者的自主神经功能受损状况 ,并了解HRV变化与肾功能水平之间的关系。方法 CRI患者 30例 ,正常人30名 ,采用Holter Star系统进行 2 4h长程心电图监测和HRV分析 ,比较两组间HRV指标的总体差异及昼夜节律性 ,并将CRI患者按肾功能受损严重程度分为三个亚组 ,观察HRV指标与肾功能指标间的关系及三个亚组间的HRV差异性。结果 与正常人相比 ,CRI患者的所有 14项HRV指标均极显著降低 ,且无昼夜节律变化 ,仅有部分HRV指标 (SDNN、SDANN、RMSSD、TINN及TriangularIndex等 )与肾功能指标 (BUN、Scr、Ccr)之间存在一定的相关性 ,而且其变化与肾功能的恶化相平行。结论 CRI患者有严重的自主神经功能受损 ,主要表现为迷走神经张力减退 ,HRV分析可作为有效的评价方法。

Objective To investigate the autonomic neuropathy in patients with chronic renal insufficiency (CRI) using heart rate variability (HRV) analysis.Methods Thirty CRI patients and thirty healthy controls were involved in this study. Long term HRV parameters (24 hour, daytime and nighttime time and frequency domains) were compared. The CRI patients were divided into three subgroups(A,B,C) according their serum BUN and Scr, Ccr. The correlation between HRV parameters and renal function parameters were also observed.Results All the fourteen HRV parameters in CRI group were much lower than those in control group. The normal difference between daytime and nighttime HRV parameters was not found in CRI patients. Some of the HRV parameters, such as SDNN, SDANN, RMSSD, TINN and Triangular Index, have slight correlation with the important renal function parameters, such as BUN, Scr and Ccr.Conclusion HRV was significantly decreased in CRI patients, whose autonomic neuropathy was mainly mediated by the reduced parasympathetic activity. The mechanism of these changes and the correlation between HRV and renal function parameters need further study.