冠心病心绞痛患者的临床表现与心率特点分析

Analysis of clinical manifestation and the characteristics of heart rate in patients with angina pectoris

目的 了解冠心病不同心绞痛类型患者的动态心率特点,及其与冠状动脉（冠脉）病变的相关性.方法 回顾性分析了188例冠心病心绞痛患者（冠心病无症状组34例、劳力性心绞痛组65例,自发性心绞痛组89例）的动态心电图（Holter）及冠脉造影（CAG）检查资料.通过Holter分析各组患者各时间段平均心率及心率变异性指标（窦性心搏R-R间期、R-R间期平均值标准差、相邻R-R间期差值的均方根和R-R间期差值＞50 ms的百分数）;并根据患者的冠脉病变情况分析心绞痛类型与心率的关系.多组间比较采用方差分析.结果 （1）自发性心绞痛患者的全天平均心率、下午、晚上及睡眠时间的平均心率较劳力性心绞痛患者明显降低[分别为（64 ±7）比（68 ±9）次/min;（66 ±8）比（71 ±9）次/min;（66 ±9）比（70±10）次/min和（61 ±8）比（66±11）次/min,F分别为2.79,3.71,2.03和3.13,P均＜0.01].（2）3组心绞痛患者的心率变异性指标差异无统计学意义（P＞0.05）;（3）劳力性心绞痛和自发性心绞痛组的患者中冠脉3支病变的患者较多[分别为42.9％（33/77）和44.2％（23/52）],无症状组患者中以单支病变为主[61.1％ （11/18）,x2=10.517,P ＜0.05].冠脉病变部位对临床表现无明显影响.结论 心率过低可能是自发性心绞痛患者的重要诱因,随冠脉病变程度的加重,自发性心绞痛的发生增加.

Objective To study the characteristics of heart rate and coronary artery abnormality in patients with different types of angina pectoris. Methods One hundred and eighty-eight patients who coronary angiography （CAG） and 24h ECG Hoher record were retrospectively studied. The subjects were classified into three groups according to the clinical manifestation： asymptomatic group, exertional angina group and spontaneous angina group. Results （ 1 ） The average heart rate of all day and during the three time-section （afternoon, night and sleeping time ） in spontaneous angina group were significantly reduced compared with exertional angina group [（64 ±7） vs （68 ±9） bpm;（66 ±8） vs （71 ±9） bpm; （66 ±9） vs （70±10） bpm and （61 ±8） vs （66±11） bpm, respectively, F=2.79,3.71,2.03 和3.13, all P〈 0.011. （2） The index of heart rate variability（ SDNN, SDANN, rMSSD and PNNS0）showed no significant difference in the three groups. （3） The percentage of patients with three-vessel coronary disease in exertional and spontaneous angina group was 42.9% （33/77） and 44.2% （23/52） respectively, whereas the majority of patients [ 61. 1% （11/18）,）（2 = 10. 517, P 〈 0. 05 ] in asymptomatic group have single-vessel coronary disease. The location of coronary artery lesions had no influence on the clinical manifestation. Conclusions An extreme low heart ,＇ate may be an important cause of spontaneous angina pectorls. The incidence of spontaneous angina increased with the increase of the degree of coronary artery lesions.