急性心肌梗死患者直接冠状动脉介入治疗术后心率变异性的相关因素分析

Analysis of correlated factors of heart rate variability in patients with AMI undergoing primary PCI

目的研究急性心肌梗死(AMI)行直接冠脉介入治疗(PPCI)后患者炎症反应对心脏自主神经功能的影响。方法纳入2013年1-5月中国医科大学附属第一医院老年病房41例AMI患者行PPCI术后,收集入院24 h内血常规中白细胞计数(WBC)、高敏C反应蛋白(hs-CRP)、血清肌酸激酶同工酶(CK-MB)及肌钙蛋白(TnI)峰值。结果 WBC计数升高的患者血清CK-MB及TnI水平显著高于WBC正常者,且心率变异性(HRV)指标SDNN显著降低。WBC计数与TnI峰值之间呈正相关(r=0.319,P=0.042),与HRV指标R-R间期总体标准差(SDNN)呈负相关(r=-0.503,P=0.009),hs-CRP与HRV指标时域指标SDNN(r=-0.325,P=0.038)及频域指标HF(r=-0.321,P=0.041)呈负相关。结论 AMI患者行PPCI术后,WBC计数与心肌坏死面积呈正相关,且白细胞计数与hs-CRP的水平越高,心率变异性下降越显著。

Objective To analyze the relationship between the markers of inflammation and heart rate variability （HRV） in patients with acute myocardial infarction （AMI） undergoing primary percutaneous coronary intervention （PPCI）. Methods Forty-one patients with AMI undergoing PPCI were enrolled. Blood samples were collected for measurement of the white blood cell count （WBC）, serum concentration of high sensitive-C reactive protein （hs-CRP）, CK-MB and troponin I （TnI） during the first 24 hour after AMI. The information of heart rate variability （HRV） was collected by 24-hour ambulatory electrocardiogram. Results Compared to the patients with normal WBC, the concentration of CK-MB and TnI was significantly higher in the patients with high WBC count, while the SDNN was decreased. In addition, a positive correlation was found between the WBC counts and serum TnI concentration （r=0.319, P=0.042）, and the WBC count was negatively correlated with SDNN （r=--0.404, P=0.009）; serum hs-CRP level was negative correlated with SDNN（r=--0.325, P=0.038）and HF（r=-0.321, P=0.041）. Conclusions In the patients with AMI after PPCI, the elevated WBC count is positively related to increased area of myocardial infarction. The WBC count and hs-CRP are negatively correlated with the HRV.