P波离散度及P波振幅对高原性心脏病患者房性心律失常发生的临床意义

Clinical value of P wave dispersion and P wave amplitude for the occurrence of atrial arrhytthmia in high altitude heart disease patients

目的探讨P波离散度(P wave dispersion,Pd)和P波振幅(P wave amplitude,Pa)在高原性心脏病(high altitude heart disease,HAHD)患者的变化及对房性心律失常发生的判断价值。方法收集山南市人民医院住院的HAHD患者87例,根据有无房性心律失常发生,分为房性心律失常组(心律失常组,n=35)与非房性心律失常组(非心律失常组,n=52)。测量最大P波时限(Pmax)与最小P波时限(Pmin),计算Pd;同步测量Pa。动态心电图分析心率变异性(heart rate variability,HRV)频域指标:低频谱功率(LF)、高频谱功率(HF)及其比值(LF/HF)。比较3组Pd、Pa及HRV频域指标。采用多因素Logistic回归分析预测房性心律失常发生的危险性。结果心律失常组Pd显著高于非心律失常组(P<0.05),两组间Pa的差异无统计学意义。心律失常组LF和LF/HF分别高于非心律失常组,HF显著低于非心律失常组(均P<0.05)。Logistic回归分析提示Pd是预测房性心律失常发生的独立危险因素。房性心律失常频率与Pd、LF和LF/HF呈正相关,而与HF呈负相关。结论 HAHD患者Pd增大与房性心律失常的发生密切相关,交感神经显著激活可能在诱发房性心律失常中起主导作用。

AIM To explore variation of P wave dispersion（Pd） and P wave amplitude （Pa） in high altitude heart disease （HAHD）patients and clinical value of the occurrence of atrial arrhytthmia. METHODS Totally 87 patients with high altitude heart disease in our hospital were chosen. According to whether the occur- rence of atrial arrhyttmia or not, 35 patients with atrial arrhytthmia were regarded as atrial arrhytthmia groupand 52 patients without atrial arrhytthmia were regarded as no-atrial arrhytthmia group. Maximum P wave duration （Pmax） and minimum P wave duration （Pmin） in three groups were measured, then Pd were calculated by the formula （ Pd = Pmax-Pmin）. Synchronous measurement of Pa were obtained. The heart rate variability（HRV） in the frequency domain was analyzed. Pd, Pa and HRV frequency domain index were respectively compared in three group. Muhivariable logistic regression analysis was performed to predict the risk of the occurrence of atrial arrhythmia. RESULTS When compared withno-atrial arrhythmia group, Pd in atrial arrhythmia group were significantly higher （ all P 〈 0. 05 ）, nevertheless there were no statistical difference in Pa between the aforementioned two groups （ P 〉 0. 05 ）. Comparedwith no-atrial arrhythmia group, low frequency（LF） and LF/HF ratio in atrial arrhythmia group cantly increased, while high frequency（HF） obviously decreased （ all P 〈0. 05 ）. Multivariable logistic regression analysis revealed that Pd was an independent predictor for atrial arrhythmia. Frequency of atrial arrhythmia. was respectively positive correlated with Pd, LF and LF/HF, nevertheless which was negative correlation with HF. CONCLUSION Increased Pd in HAHD patients is closely related with the occurrence of atrial arrhythmia, sympathetic apparent activation plays a leading role in inducing it, however Pa fails to predict the occurrence of atrial arrhytthmia.