心率减速力与冠状动脉病变范围的相关性研究

The Relationship Between Deceleration Capacity of Rate and the Scope of Coronary Artery Lesions

目的探讨心率减速力与冠状动脉病变范围和严重程度的相关性。方法纳入本院同时接受320排动态容积CT冠状动脉造影检查和24 h动态心电图(24 h DCG)监测的住院患者共270例,同时收集患者吸烟史、血脂、血糖、血压等临床指标。根据冠状动脉CT结果分为冠心病组、对照组。分析两组患者的临床指标和心率减速力(DC值)、心率加速力(AC值)和猝死危险分层的差异,判断DC值、AC值和猝死风险分层与冠脉病变严重程度、病变范围的相关性。结果冠心病组的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(Apo A)水平均较对照组增高,载脂蛋白B(Apo B)则较对照组下降(P<0.05)。相比对照组,冠心病组的DC值明显下降,AC值明显升高,猝死危险分层则明显升高,差异具有统计学意义。DC值与猝死危险分层、冠脉病变支数、Gensini评分均呈负相关,AC值与猝死危险分层、病变支数、Gensini评分均呈正相关,猝死危险分层与病变支数、Gensini评分均呈正相关,差异具有统计学意义。结论心率减速力能够定量评估自主神经,与冠状动脉病变程度、病变范围密切相关,是冠状动脉粥样硬化性心脏病的一项重要预测指标。

Objective To investigate the relationship between the deceleration capacity of rate and the severity of coronary artery lesions. Methods 270 patients were performed 320 slices spiral CT and 24 hours Holter recording from Jul 2012 to Jun 2013. Age,gender,smoking,blood glucose and blood lipids were recorded. All cases were divided into two groups including coronary atherosclerosis group and control group according to the results of coronary CT angiography. The relationships between deceleration capacity of rate（ DC）,acceleration capacity（ AC）,risk stratifications of sudden death and the severity of coronary artery lesions were analyzed. Results CHOL,TRIG,LDL-C and Apo A in coronary atherosclerosis group were significantly higher than those in control group（ P 0. 05）. Apo B in coronary atherosclerosis group was significantly lower than that in control group（ P 0. 05）. DC in coronary atherosclerosis group was significantly lower than that in control group. AC in coronary atherosclerosis group was significantly higher than that in control group. The risk stratification of sudden death in coronary atherosclerosis group was significantly higher than that in control group. Negative correlation between the risk stratification of sudden death,the number of coronary artery stenosis,Gensini score and DC was observed（ P 0. 05）. Positive correlation between the risk stratification of sudden death,the number of coronary artery stenosis,Gensini score and AC was observed（ P 0. 05）. The risk stratification of sudden death was positively correlated with the number of coronary artery stenosis and Gensini score（ P 0. 05）. Conclusion DC can quantitatively assess autonomic nervous function. DC was associated with the severity and scope of coronary artery stenosis. DC was an important predictor of coronary artery disease.