冠状动脉慢血流对心率变异性的影响及氯吡格雷干预的疗效观察

Effect of coronary slow flow on HRV and observation of therapeutic effect of clopidogrel

目的探讨冠状动脉慢血流(coronary slow flow,CSF)对心率变异性(heart rate variability,HRV)的影响以及氯吡格雷干预的疗效。方法随机选取2011年9月至2015年9月本院因临床疑诊为冠心病而行冠状动脉造影(coronary angiography,CAG)检查的患者,根据CAG结果分为CSF组(55例)、狭窄组(55例)、对照组(55例),分别进行HRV的时域和频域分析,并比较三组患者的正常RR间期的标准差(SDNN)、平均正常RR间期的标准差(SDANN)、相邻正常RR间期差值的均方根值(RMSSD)、相邻RR间期之差大于50 ms的心搏次数占总心搏次数的百分比(PNN50)。观察三组患者在常规干预和随访的6个月内有无主要不良心脏事件(major adverse cardiac events,MACEs)发生。CSF组患者口服氯吡格雷6个月再次行CAG和HRV检查,比较并分析其冠状动脉血管病变、血流情况及HRV指标(SDNN、SDANN、RMSSD、PNN50)。结果 CSF组、狭窄组患者HRV的SDNN、SDANN、RMSSD、PNN50较对照组均明显下降(P<0.05)。随访6个月,CSF组、狭窄组、对照组患者MACEs发生率分别为63.6%、56.4%、7.3%。CSF组患者氯吡格雷治疗6个月后,HRV各项参数及CAG检查结果与治疗前比较均具有显著差异(P<0.05)。结论 CSF患者HRV减低,发生MACEs的风险增加;氯吡格雷有改善CSF患者冠状动脉血流、提高HRV的作用。

Objective To explore the influence of coronary slow flow （CSF） and clopidogrel intervention on heart rate variability （HRV）. Method The study was conducted on 165 suspected coronary artery disease patients who received CAG test in the First People＇s Hospital of Huaihua, between September 2011 and September 2015. They were divided into CFS group, coronary stenosis group and normal control group （55 cases in each） according to CAG results. The time domain analysis and frequency domain analysis of HRV were performed and Standard deviation of normal-to-normal intervals （SDNN）, standard deviation of the minute mean cycle lengths （SDANN）, root mean square successive difference （RMSSD） and percentage of differences exceeding 50 ms between adjacent normal to normal interval （PNN50） were compared among 3 groups. 3 groups were followed up for 6 months with conventional intervention therapy to observe the major adverse cardiac events （MACEs, including unstable angina, myocardial infarction, malignant arrhythmia）. CSF group patients were treated with coronary angiography （CAG） and HRV to analyze and compare coronary blood flow and HRV value （SDNN, SDANN, RMSSD, PNN50） after taking clopidogrel for 6 months. Result The parameters of HRV （SDNN, SDANN, RMSSD, PNN50） had significantly decreased in patients in CSF group and coronary artery stenosis group compared to control group （P 〈 0.05）. During 6-month follow up, the incidence of MACEs in CSF group, coronary artery stenosis group and normal coronary artery group were 63.6%, 56.4%, 7.3%, respectively. After treating with clopidogrel for 6 months, CAG and HRV values （SDNN, SDANN, RMSSD, PNN50） had significant differences in CSF group patients than before treatment （P 〈 0.05）. Conclusion HRV decreased and risk of cardiac events increased in CSF patients. Clopldogrel can improve blood flow of CSF and HRV.