原发性高血压病患者交感神经与迷走神经张力对静息心率的影响研究

Effect of Sympathetic and Vagal Tone on Resting Heart Rate among Essential Hypertensive Patients

目的探讨原发性高血压病患者交感神经、迷走神经张力变化对静息心率(RHR)的影响。方法选取2013年于武汉市第一医院门诊及住院治疗的原发性高血压病患者404例为研究对象。记录标准12导联心电图,用平均RR间期计算出RHR。根据RHR,将患者分为RHR-L组(<60次/min)、RHR-M组(60~<75次/min)和RHR-H组(≥75次/min)。随即接受24 h动态心电图记录,离线应用动态心电记录分析系统,计算极低频带(VLF)、低频带(LF)、高频带(HF)、心率减速力(DC)值。结果各组VLF、LF、HF、DC、LF/HF比较,差异均有统计学意义(P<0.05);其中,RHR-M组VLF、LF、HF低于RHR-L组,RHR-H组VLF、LF、HF、DC低于RHR-L组、RHR-M组,RHR-H组LF/HF高于RHR-L组、RHR-M组(P<0.05)。RHR与VLF[r=-0.436,95%CI(-0.501,-0.369)]、LF[r=-0.290,95%CI(-0.378,-0.205)]、HF[r=-0.394,95%CI(-0.468,-0.315)]、DC[r=-0.219,95%CI(-0.310,-0.123)]呈负相关(P<0.001),与LF/HF[r=0.248,95%CI(0.158,0.332)]呈正相关(P<0.001)。多因素线性回归分析显示,VLF、HF、LF/HF是原发性高血压病患者RHR的影响因素(P<0.05)。结论 RHR为60~<75次/min的原发性高血压病患者RHR主要受到迷走神经紊乱影响,而RHR≥75次/min的患者RHR则主要受到交感神经系统紊乱影响。

Objective To investigate the effects of sympathetic and vagal tone changes on resting heart rate（ RHR） in patients with essential hypertension. Methods 404 cases of essential hypertension outpatients and hospitalized patients were selected as the subjects from Wuhan No. 1 Hospital in 2013. Recorded the standard 12-lead ECG,calculated the RHR using the average RR interval. The patients were divided into RHR-L group（ 60 times/min）,RHR-M group（ 60- 75 times/min）and RHR-H group（ ≥75 times/min） according to RHR. Followed by 24 h dynamic electrocardiographic recording,the value of very low frequency band（ VLF）, low frequency band（ LF）, high frequency band（ HF） and heart rate deceleration force（ DC） were calculated using off-line application of dynamic ECG recording and analysis system. Results The VLF,LF,HF,DC,LF/HF of each group were compared,and the differences were statistically significant（ P〈0. 05）. Among them,VLF,LF and HF in RHR-M group were lower than those in RHR-L group. VLF,LF,HF,and DC in RHR-H group were lower than those in RHR-L group and RHR-M group. LF/HF in RHR-H group was higher than RHR-L group and RHR-M group（ P〈0. 05）. The RHR was negatively correlated with VLF [r =-0. 436,95% CI（-0. 501,-0. 369） ],LF [r =-0. 290,95% CI（-0. 378,-0. 205） ], HF [r =-0. 394,95% CI（-0. 468,-0. 315） ], DC [r =-0. 219,95% CI（-0. 310,-0. 123） ]（ P〈0. 001）,and it was positively correlated with LF/HF [r = 0. 248,95% CI（ 0. 158,0. 332） ]（ P〈0. 001）. Multivariate linear regression analysis showed that VLF,HF and LF/HF were the influencing factors of RHR in patients with essential hypertensive（ P〈0. 05）. Conclusion RHR in essential hypertension patients with RHR of 60- 75times/min are mainly affected by vagal disturbances,while RHR in patients with RHR ≥75 times/min are mainly affected by sympathetic nervous system disorders.