神经介导性晕厥患者心率变异性分析

Heart rate variability in patient with neurally mediated syncope

目的 评价神经介导性晕厥（NMS）患者的心率变异性（HRV）.方法 选择2015年7月至12月在复旦大学附属中山医院就诊的疑似NMS患者并符合入选标准共69例为晕厥病例组,行直立倾斜试验（HUTT）及动态心电图监测,同选69例健康体检人群为健康对照组.比较2组的HRV差异.结果 ①晕厥病例组69 例经HUTT诊断,阳性反应者共49 例,诊断阳性率71.0％.阳性反应类型中混合型29例（59.2％）,心脏抑制型7例（14.3％）,血管抑制型13例（26.5％）.②病例组与对照组HRV指标相比,24 h最慢心率显著降低（47.46±6.73对54.59±7.52,P〈0.01）,时域指标：总体标准差（SDNN）（148.87±34.67对117.55±23.69,P〈0.01）、均值标准差（SDANN）（135.33±35.95对105.72±23.74,P〈0.01）、差值均方根（rMSSD）（33.83±15.84对25.17±9.36,P〈0.01）、差值大于50 ms的百分比（PNN50）（11.16±9.83对5.96±6.59,P〈0.01）明显升高,频域指标：低频功率（LF）（21.61±9.17对16.94±5.77,P〈0.01）、高频功率（HF）（13.43±6.10对11.16±4.85,P〈0.05）明显升高.③HUTT阳性组与阴性组HRV指标比较差异无统计学意义（P〉0.05）.④不同血流动力学分型HRV指标比较差异无统计学意义（P〉0.05）.结论 NMS患者自主神经功能失衡,以增加的迷走神经活性为主.

Objective The aim of this study was to investigate the heart rate variability（HRV）in patients with neurally mediated syncope（NMS）.Methods Sixty-nine patients who were scheduled to undergo head-up tilt-table test（HUTT）with a typical history of neutrally mediated syncope underwent 24-hour Holter electrocardiogram monitoring in order to study the HRV parameters.Sixty-nine healthy individuals without syncope and similar baseline characteristics made up of the control group.HRV parameters of two groups were compared.Results ①Among 69 NMS patients,49（71.0%）had a positive response to HUTT.Twenty-nine（59.2%）of them were mixed type responses,7（14.3%）were cardioinhibitory type responses,and 13（26.5%）patients showed vasodepressor type responses.②The minimum heart rate during 24-hour Holter monitoring was significantly lower in NMS group compared to control group（47.46±6.73 vs.54.59±7.52,P〈0.01）.Time-domain parameters of SDNN（148.87±34.67 vs.117.55±23.69,P〈0.01）、SDANN（135.33±35.95 vs.105.72±23.74,P〈0.01）、rMSSD（33.83±15.84 vs.25.17±9.36,P〈0.01）、PNN50（11.16±9.83 vs.5.96±6.59,P〈0.01）showed significant increase in NMS group in comparison to control group.And the frequency-domain parameters of LF（21.61±9.17 vs.16.94±5.77,P〈0.01）、HF（13.43±6.10 vs.11.16±4.85,P〈0.05）also showed significant increase in NMS group compared to control group.③There was no significant difference between the HUTT positive group and negative group in any HRV parameter（P〉0.05）.④The HRV indices revealed no significant differences among the three hemodynamic types of response to HUTT（P〉0.05）.Conclusion The results of this study indicated that patients with NMS had an imbalance of the autonomic nervous function by increased vagal tone compared to healthy controls.