妊娠期糖尿病合并妊娠期高血压昼夜血压节律与心率变异性的相关性分析

Analysis of Correlation Between Blood Circadian Rhythm and Heart Rate Variability of Patients with Gestational Diabetes Mellitus Combined with Hypertension Disorder Complicating Pregnancy

目的:探讨妊娠期糖尿病(gestational diabetes mellitus GDM)合并妊娠期高血压疾病(hypertension disorder complicating pregnancy HDCP)患者昼夜血压节律与心率变异性(Heart Rate Variability HRV)变化规律及其相关性。方法:选取GDM合并HDCP 25例(Ⅰ组),GDM 25例(Ⅱ组),HDCP 25例(Ⅲ组),正常妊娠孕妇25例(IV组),进行动态血压(ambulatory blood pressure monitoring,ABPM)及动态心电图(dynamic electrocardio gram,DCG)同步监测,分析24 h昼夜血压节律与HRV变化及其相关性。结果:1ABPM:昼夜节律Ⅰ组低于Ⅳ组,差异具有统计学意义(P<0.05),Ⅰ组与Ⅱ组、Ⅲ组比较,差异无统计学意义(P>0.05)。2HRV:SDNN、SDNNindex、SDANN、RMSSD,Ⅰ组低于IV组,差异具有统计学意义(P<0.05),Ⅰ组与Ⅱ组、Ⅲ组比较,差异无统计学意义(P>0.05)。结论:昼夜血压节律改变与HRV的改变具有相关性,GDM合并HDCP者自主神经调节功能下降,在治疗时应注意平稳血压及血糖波动范围,尽可能恢复昼夜血压节律及改善心率变异性各项指标,以减轻自主神经受损所致的危害性。

Objective ：To explore the variation rules and correlation between the blood pressure circadian rhythm and the heart rate variability （HRV） in cases with gestational diabetes mellitus （ GDM ） with hypertension disorder complicating pregnancy （ HD- CP）. Methods：One hundred patients were chosen and divided into group I with GDM and HDCP, group Ⅲ with GDM, group Ⅲ with HDCP,and group IV with normal pregnancy,with 25 cases in each group. The DCG and the ABPM are synchronously moni- tored. The changes and the correlations between the 24-hour circadian blood pressure rhythm and heart rate variability are collect- ed and analyzed. Results：In terms of ABPM ,circadian rhythm of blood pressure of group I was lower than that of group IV, and the difference between them had statistical significance （ P 〈 0.05 ） , but group I and group lI and group m had no statistical differences and the differences between them had no statistical significance （ P 〉 0.05 ）. In terms of HRV, SDNN, SDNN index, SDANN and RMSSD of group I were lower than those of group IV, and all the differences between them had statistical signifi- cance （P 〈 0.05） ,but group Ⅰ and group Ⅱ and groupⅢ had no statistical differences and the differences between them had no statistical significance （ P 〉 0.05 ）. Conclusion ： There is correlation between the blood pressure circadian rhythm and HRV. Autonomic nervous regulation function of the patients with GDM combined with HDCP decline, so in treatment stable blood pres- sure and blood sugar fluctuations should be paid attention to, and each index of the blood pressure circadian rhythm and HRV should be restored as much as possible to reduce the harm of autonomic nerve injury.