代谢因素与原发性高血压患者自主神经功能的相关性研究

Correlation between metabolic parameters and autonomic nervous function in patients with essential hypertension

目的探讨代谢因素与原发性高血压患者自主神经功能的相关性:方法纳入原发性高血压患者160例,收集一般资料,检测其生化指标并进行24h动态心电图检查,分析心率变异性(HRV)时域指标[包括全部正常窦性心搏间期的标准差(SDNN)、每5min的窦性心搏间期平均值的标准差(SDANN)、相邻的窦性心搏间期之差〉50ms的心搏数占总的窦性心搏间期个数的百分比(PNN50)],采用Spearman相关分析和偏相关分析评估代谢指标与HRV相关指标的相关性。结果160例原发性高血压患者中,高尿酸患者38例(23.8%),高同型半胱氨酸(Hey)患者70例(43.8%),高空腹血糖(FPG)患者44例(27.5%),血脂异常患者89例(55.6%)。高尿酸组和尿酸正常组、高FPG组和FPG正常组、血脂异常组和血脂正常组患者SDANN、SDNN及pNN50比较,差异均无统计学意义(P〉0.05);而高Hey组患者SDANN、SDNN及pNN50均低于Hey正常组(P<0.05)。Spearman相关分析结果显示,血浆Hey水平与SDNN及pNN50均呈直线负相关(r=-0.16,P=0.04;r=-0.19,P=0.01),而与SDANN呈临界直线负相关(r=-0.15,40.05)。进一步校正混杂因素后,结果显示血浆Hey水平仍与pNN50呈直线负相关(r=-0.18,P=0.03),而与SDNN呈临界直线负相关(r=-0.15,P=0.06),与SDANN无相关性(r=-0.14,P=0.08),而其余代谢指标与SDNN、SDANN、pNN50均无相关性(P>0.05)。结论原发性高血压患者血浆Hey水平升高与心脏自主神经功能紊乱存在线性相关关系。

Objective To explore the correlation between metabolic parameters and autonomic nervous function in patients with essential hypertension. Methods A total of 160 patients with essential hypertension subjects were concluded. The general data were collected. Biochemical indexes were detected, 24 h ambulatory electrocardiogram recording was conducted and time domain indexes of heart rate variability ]HRV, including standard deviation of all normal sinus RR intervals( SDNN ), standard deviation of the mean of each RR interval ( SDANN), percentage of time difference between adjacent cardiac cycle > 50 ms in all sinus cardiac cycles( pNN50)] were analyzed. Spearman correlation analysis and partial correlation analysis were conducted to evaluate the correlation between metabolic parameters and HRV-related indexes. Results There were 38(23. 8%) patients with high uric acid ( UA),70(43. 8%) patients with high homocysteine( Hey),44(27. 5%) patients with high fasting plasma glucose ( FPG) and 89 ( 55. 6%) patients with dislipidemia in 160 patients with essential hypertension. There were no significant differences of SDNN, SDANN and pNN50 between high UA group and normal UA group, high FPG group and normal FPG group, dislipidemia goup and normal lipid group( P < 0. 05). Results of Spearman coiTelation analysis showed that plasma Hey level was linear negative correlated with SDNN and pNN50(r =-0. 16,P =0. 04;r =-0. 19 =0. 01 ), but was critical linear negative correlated with SDANN( r =- 0. 15 , P = 0. 05 ). After adjustment of confounding factors, the results showed that plasma Hey level was linear negative correlated with pNN50 ( r =- 0. 18 , P = 0. 03 ), but was critical linear negative correlated with SDNN (r =-0. 15 =0. 06) and was not significantly correlated with SDANN ( r =- 0. 14,P = 0. 08 ). Other metabolic parameters were not significantly correlated with SDNN, SDANN and pNN50 ( P>0. 05 ). Conclusion Increased plasma Hey level is linear correlated with cardiac autonomic nervous function disorders in patients with essential hypertension.