高血压合并糖耐量减低患者的心率变异性

Heart rate variability in patients with essential hypertension associated with impaired glucose tolerance

【摘要】目的观察原发性高血压（EH）及EH合并糖耐量减低（IGT）患者心率变异性（HRV）的变化，探讨EH、EH合并IGT患者自主神经功能的改变。方法从门诊体检人群中筛选病例166例，其中EH组62例，EH合并IGT组56例，健康对照组48例，测定HRV及相关生化指标。结果EH组与健康对照组比较，R-R间期的标准差（SDNN）、5min窦性R-R间期平均值的标准差（SDANN）、每5min窦性R-R间期标准差的平方根（SDNNi）、窦性相邻R-R间期差值〉50ms的心搏数占窦性总搏数的百分比（PNN50）均下降，C肽、高敏C反应蛋白（hs．CRP）升高，差异有统计学意义（P〈0．05）。EH合并IGT组与健康对照组比较，SDNN、SDANN、SDNNi、相邻R．R间期之差的均方根（rMSSD）、PNN50均下降，C肽、胰岛素、hs-CRP升高，差异有统计学意义（P〈0．01）。EH合并IGT组与EH组比较，rMSSD、PNN50下降明显，差异有统计学意义（P〈0．叭）；C肽、胰岛素、hs—CRP升高，差异有统计学意义（P〈O．05或〈0．01）。结论EH、EH合并IGT者HRV指标均下降，提示存在自主神经功能损害，且后者更严重，可能与胰岛素抵抗、hs—CRP升高相关。

Objective To observe the changes of heart rate variability （HRV） in patients with essential hypertension （EH） and EH associated with impaired glucose tolerance （IGT）,and explore the change of autonomic nerve function in EH or EH associated with IGT patients. Methods A total of 166 individuals were enrolled from the physical examination center and divided into three groups, EH group （62 patients ）, EH associated with IGT group （56 patients ） and control group（48 healthy individuals）. HRV and its correlative biochemical indexes were detected. Results Compared with that in control group, the standard deviation of NN intervals （SDNN）, standard deviation of average NN intervals in all 5 min segments of the entire recording （SDANN）, standard deviation of average NN intervals in all 5 min segments of the entire recording index （SDANNi）, the percentage of R-R intervals differing 〉 50 ms （PNN50） decreased and C-peptide,high sensitivity C-reactive peptide （hs-CRP） level increased in EH group, and there was significant difference （P 〈 0.05）. Compared with that in control group, SDNN, SDANN, SDANNi, root mean square of successive differences （rMSSD）, PNN50 decreased and C-peptide, insulin, hs-CRP level increased significantly in EH associated with IGT group, and there was significant difference （P 〈 0.01 ）. Compared with that in EH associated with IGT group, rMSSD, PNN50 decreased, C-peptide ,insulin and hs-CRP level increased in EH group, and there was significant difference （P 〈 0.05 or 〈 0.01 ）. Conclusions HRV decreases in patients with EH and EH associated with IGT, reflecting the damage of autonomic function. Moreover,it suggests that the damage of autonomic function may associate with the increased insulin and hs-CRP.