基于心率变异性近似熵分析的冠心病慢性稳定性心绞痛虚实证候的混沌特征研究

Chaotic Features on Excess/Deficiency Syndrome of Chronic Stable Angina Pectoris Based on Analyzing Approximate Entropy of Heart Rate Variability

目的通过观察全天每小时心率变异性近似熵指标的变化,分析冠心病慢性稳定性心绞痛(chronic stable angina pectoris,CSAP)患者虚实证候的混沌程度及其昼夜动态变化特征。方法 2009年11月—2011年6月共纳入187例CSAP患者,依据中医证候辨证标准分为实证(36例)、虚证(42例)及虚实夹杂证(109例)。采用美国DMS动态心电图记录仪采集患者全天24 h的心电信号,分为24个连续的每小时时间段,分别计算每个小时的近似熵指标,分析不同中医证候患者近似熵水平的昼夜变化趋势。以同期医院体检,且体检报告正常的30名健康人作为对照。结果与健康组比较,CSAP各证型组患者全天每个小时的近似熵值降低(F=7.847,P<0.01);实证、虚实夹杂证及虚证组间差异虽无统计学意义(F=1.585,P=0.208),但表现为实证>虚实夹杂证>虚证的趋势。从晨8:00至次日7:00,4组曲线的变化趋势均表现出随时间推移近似熵水平发生改变的特征(F=2.655,P<0.01),且CSAP实证、虚证及虚实夹杂证患者昼夜变化趋势一致(F=1.011,P=0.457),均异于健康组(F=1.583,P=0.003),健康组曲线形态表现为"双峰一谷"型,即日间10:00—14:00、夜间22:00—02:00各有一高峰。实证、虚证及虚实夹杂证组患者的曲线均呈反勺型,即仅有夜间的高峰,日间8:00—19:00表现为变化相对平稳的一段曲线。与健康组比较,CSAP患者日峰消失,日间近似熵明显降低(F=10.315,P<0.01)。结论相对于健康人,CSAP患者近似熵水平下降,即混沌程度降低,心血管系统对外界环境变化的适应性减弱,白天较夜间表现更明显。CSAP实证、虚实夹杂证和虚证之间的混沌程度呈依次逐渐降低的趋势。

Objective To analyze the chaotic degree of excessdeficiency syndrome （ES/DS） in chronic stable angina pectoris （CSAP） patients by observing 24-h dynamic changes of approximate entropy index of heart rate variability per hour, and to observe dynamic changing features. Methods From November 2009 to June 2011, a total of 187 CSAP patients were assigned to ES （36 cases）, DS （42 cases）, intermingled syndrome of deficiency and excess （109 cases, abbreviated as intermingled ES/DS） according to TCM syndrome differentiation standards. 24 h dynamic electrocardiograms were collected u- sing USA DMS dynamic ECG, which was then divided into 24 continuous period by hour. The approximate entropy algorithm （by hour） was respectively calculated. The approximate entropy diurnal variation trend was analyzed in patients with different TCM syndromes. These results were controlled with 30 healthy subjects who had normal physical examinations at the same hospital. Results The approximate entropy mean value of each hour throughout the day was lower, as compared with the healthy group （F=7. 847, P 〈0. 01）. Although no statistical difference existed among ES, DS, intermingled ES/DS （F =1. 585, P = 0.208）, the approximate entropy mean value showed the tendency of ES 〉 intermingled ES/DS 〉 ES. From 8：00 a.m. to 7：00 a.m. on the next day, the variation tendency of four-group curves all showed that the approximate entropy level changed as time went by （F =2.655, P 〈0.01 ）. Besides, the approximate en- tropy diurnal variation of ES, DS, intermingled ES/DS showed a similar trend （F = 1.011 ,P =0.457）, but different from the healthy group （F = 1. 583, P =0.003）. The curve in the healthy group showed ＂two peaks and one valley＂ type [one peak from 10：00 to 14：00, and the other peak from 22：00 to 02：00]. The curve for ES, DS, intermingled ES/DS showed an inverted dipper type [only a peak at night, and a relatively stable curve from 8：00 to 19：00 ]. Compared with the normal group, the day peak disappeared in CSAP patients, and the daytime approximate entropy was significantly reduced （F =10.315, P 〈0.01 ）. Conclusions Compared with the healthy group, the approximate entropy of CSAP patients decreased, which means the chaotic degree reduced. The adaptability of the cardiovascular system to external environment changes was weakened, which was more obviously seen at daytime than at night. The chaotic degree showed gradually decreasing trend （ ES 〉 DS 〉 intermingled DS/ES）.