阵发性房颤患者心率减速力的变化及其临床意义

Changes and clinical significance of deceleration capacity of rate in patients with paroxysmal atrial fibrillation

目的探讨阵发性房颤患者心率减速力(deceleration capacity of rate,DC)的变化及其临床意义。方法选取2015年1月至2016年10月我院住院患者中确诊为阵发性房颤的90例患者(PAF组)和同时期健康体检者133例(对照组),行24 h动态心电图和心脏超声心动图检查,分析并比较两组的心率减速力(DC)、心率加速力(AC)、心率变异性(HRV)指标以及左房内径(LAD)和左室射血分数(LVEF)。结果 (1)与对照组相比,PAF组患者的DC值、AC绝对值、SDNN、r MSSD和LAD值均显著升高(P<0.05),24 h平均心率和LF/HF指标均显著降低(P<0.05)。(2)无论是对照组还是PAF组,其组内男女间DC值无明显差异,但与对照组同性别间相比,PAF组男性DC值显著升高(P<0.05),而女性DC值呈升高趋势。(3)无论是对照组还是PAF组,其DC值与年龄均呈负相关(r<-0.262 vs.r<-0.548,P均<0.01);与对照组同年龄段者相比,PAF组年龄<60岁者的DC值显著升高(P<0.05),而≥60岁者的DC值呈升高趋势。(4)与对照组相比,PAF组LAD值显著升高(P<0.05),但PAF组患者无论是LAD≤40 mm还是LAD>40 mm,其DC值均显著高于对照组(P<0.05)。结论阵发性房颤患者的DC值升高,提示迷走神经张力增加。该指标与患者年龄呈负相关。

Objective To investigate the changes and clinical significance of deceleration capacity of rate（ DC） in patients with paroxysmal atrial fibrillation（ PAF）. Methods Ninety patients diagnosed with PAF（ PAF group） were selected from the inpatients in our hospital from January 2015 to October 2016 while 133 healthy subjects were selected as control group. They underwent 24-hour ambulatory electrocardiography and echocardiography examinations. Between the two groups,their DC,acceleration capacity of heart rate（ AC）,heart rate variability（ HRV）,left atrial diameter（ LAD） and left ventricular ejection fraction（ LVEF） were compared and analyzed. Results（ ⅰ）Compared with the control group,DC value,absolute value of AC,SDNN,r MSSD and LAD all significantly increased in PAF group（ P〈0. 05） while the 24-hour average heart rate and LF/HF bothsignificantly decreased（ P〈0. 05）.（ ⅱ） There was no significant difference of DC value between males and females in either group. However,if compared with the same sex in the control group,DC value of males in PAF group significantly increased（ P〈0. 05） while the value showed an increasing trend in females.（ ⅲ） Whether in the control group or in PAF group,DC value was negatively correlated with age（ r -0. 262 vs. r -0. 548,P〈0. 01）. If compared with those in the same age subgroup of the control group,the DC value of the patients younger than 60 years old in PAF group significantly increased（ P〈0. 05） while the value showed an increasing trend in those older than 60 years old.（ ⅳ） The LAD value of patients in PAF group was significantly higher than that in control group（ P〈0. 05）. However,the DC values in PAF group were both significantly higher than those in control group（ P〈0. 05） whether for those with LAD ≤40 mm or those with LAD 40 mm. Conclusion Increased DC value in PAF patients suggests increased tension of vagus nerve. The index is negatively correlated with age of patients.