慢性心力衰竭患者6分钟步行试验与心率震荡的相关性研究

Correlation between 6-minute walk test and heart rate turbulence in patients with chronic heart failure

目的：评价慢性心力衰竭患者6 min步行试验（6MWT）与心率震荡（ HRT）的相关性。方法：纳入2012年4月至2014年3月中山市东凤人民医院收治的慢性心力衰竭患者165例，按6MWT的结果分组：步行距离＜300 m为Ⅰ组，300～374.9 m为Ⅱ组，375～449.9 m为Ⅲ组，＞450 m为Ⅳ组。各组患者行动态心电图检查，计算HRT的震荡初始值（ TO）、震荡斜率（ TS）。对HTR与6MWT进行Spearman相关分析。结果：Ⅰ－Ⅳ组各纳入了30、35、40、60例患者，4组患者年龄、性别、高血压病、冠心病、高脂血症及糖尿病史方面比较，差异无统计学意义（P＞0.05）。4组患者TO、TS值比较，差异有统计学意义（P＜0.05），其中Ⅰ组和Ⅱ组TO值与Ⅳ组比较均显著增高（ P＜0.05）；Ⅰ组、Ⅱ组和Ⅲ组TS值与Ⅳ组比较均显著降低（ P＜0.05）。慢性心力衰竭患者6MWT与TO值呈负相关，而与TS值呈正相关（ P＜0.05）。结论：慢性心力衰竭患者窦性6MWT与HRT相关，6MWT的距离越短，其心脏自主神经调节功能越差。

Objective：To evaluate the correlation between 6-minute walk test （ 6MWT ） and heart rate turbulence （HRT） in patients with chronic heart failure （CHF）. Methods： A total of 165 patients with CHF hospitalized in Dongfeng Municipal People’ s Hospital in Zhongshan city between April 2012 and March 2014 were included and divided into groups based on 6MWT （ Group I：walking distance〈300 m, Group II：300～374. 9 m, Group III：375～449.9 m, Group IV：〉450 m） . All patients were detected by dynamic electrocardiogram to calculate the turbulence onset （ TO） and turbulence slope （ TS） of HRT. Meanwhile, HTR and 6MWT were analyzed by Spearman correlation. Results：Group I-IV included 30, 35, 40 and 60 patients, respectively. And there were no statistically significant differences in the age, sex, and history of hypertension, coronary heart disease, hyperlipoidemia and diabetes among the 4 groups （P〉0.05）. The differences in the TO and TS value among the 4 groups were statistically significant （P〈0.05）. The TO value in group I and group II significantly increased compared with that in group IV （P〈0.05）. And the TS value in group I, group II and group III significantly decreased compared with that in group IV （ P〈0.05） . The 6MWT was negatively correlated with TO value and positively correlated with TS value in CHF patients （ P〈0. 05 ） . Conclusion： The sinus 6MWT is correlated with HRT in CHF patients that the regulation of heart autonomic nerve becomes worse along with the shorter distance of 6MWT.