COPD合并不同程度肺动脉高压患者的心率变异性分析

Analysis of heart rate variability in patients with chronic obstructive pulmonary disease complicated with different degrees of pulmonary hypertension

目的通过观察慢性阻塞性肺疾病(COPD)合并不同程度肺动脉高压(PH)患者的心率变异性(HRV)指标的差异,来探讨两者之间的关系。方法选取2013年1月-2018年12月在我院住院的COPD合并PH患者69例,选取肺动脉压力在正常范围内的健康体检者35例为对照组,对两组患者行24h动态心电图检查,观察不同程度肺动脉压力患者的心率变异性指标之间的差别,并将肺动脉压力与心率变异性指标之间进行相关分析。结果轻中度组与对照组比较,SDNN、SDNN index、RMSSD三个指标均有不同程度的降低,差异有统计学意义(P<0.05),SDANN、PNN50两个指标与对照组比较也有一定程度的降低,但差异无统计学意义(P>0.05)。重度PH组与对照组比较SDNN、SDNN index、RMSSD、SDANN、PNN50均有一定程度的下降,差异均有统计学意义(P<0.05)。PH重度组与轻中度组比较,上述五个HRV指标也有一定的下降,差异均有统计学意义(P<0.05)。肺动脉压力与心率变异性时域指标呈负相关关系,与SDNN、SDNNindex、PNN50的相关系数分别为-0.391、-0.297、-0.368,P均<0.05。与SDANN的相关系数为-0.162,P值为0.101,差异无统计学意义。与RMSSD的相关系数r=-0.541,P<0.001。结论随着肺动脉压力程度的加重,心率变异性指标呈下降趋势。应重视COPD合并重度PH患者心律监测,防止心血管不良事件发生。

Objective To investigate the relationship between pulmonary hypertension and heart rate variability indicators by observing the difference of heart rate variability indicators in patients with chronic obstructive pulmonary disease (COPD) complicated with different degrees of pulmonary hypertension (PH). Methods Sixty-nine patients with COPD complicated with pulmonary hypertension who were admitted into our hospital from January 2013 to December 2018 were enrolled as the observation group. Thirty-five healthy subjects with normal pulmonary artery pressure were enrolled as the control group. The patients in the two groups were examined by using 24-hour dynamic electrocardiogram (DCG). We observed the differences of heart rate variability indexes in patients with different degrees of pulmonary artery pressure,and the correlation between pulmonary pressure and heart rate variability indexes was analyzed. Results SDNN,SDNN index,RMSSD were significantly decreased in the mild to moderate group compared with the control group,there was statistical difference ( P <0.05);SDANN,PNN50 also decreased to a certain extent compared with the control group,but the difference was not statistically significant ( P >0.05). Compared with the control group,the severe pulmonary hypertension group had a certain decrease of all SDNN,SDNN index,RMSSD,SDANN,and PNN50,there were all statistically significant differences ( P <0.05). Compared with the mild to moderate group,the severe pulmonary hypertension group had a certain decrease of all the five mentioned above indicators of heart rate variability,there were all statistically significant differences ( P <0.05). Pulmonary artery pressure had a negative correlation with time domain indexes of heart rate variability,its correlation coefficients with SDNN,SDNN index,PNN50 were -0.391,-0.297 and -0.368,respectively,all P <0.05,and its correlation coefficient with SDANN was -0.162, P value was 0.101,there was no statistical difference,and its correlation coefficient with RMSSD was r =-0.541, P <0.001. Conclusion With the aggravation of pulmonary artery pressure,the heart rate variability index shows a decreasing trend. We should pay attention to heartbeat monitoring for patients with COPD complicated with pulmonary pressure so as to prevent the incidence of adverse cardiovascular events.