左心室射血分数保留的老年心力衰竭病人心率变异性与血浆氨基末端脑钠肽前体的相关性分析

Correlation analysis of heart rate variability and N-terminal probrain natriuretic peptide precursor in elderly patients with heart failure with left ventricular ejection fraction

目的探讨左心室射血分数保留的老年心力衰竭(HFpEF)病人心率变异性(HRV)与血浆氨基末端脑钠肽前体(NT-proBNP)的相关性,为HFpEF的诊断提供参考指标。方法选取阆中市人民医院2014年1月至2017年5月住院的98例慢性心功能衰竭(CHF)老年病人为心衰组,男性54例,女性44例,年龄(70.0±6.3)岁;根据美国纽约心脏协会(NYHA)心功能分级分为心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组。选择同期住院的41例无CHF老年病人为对照组,男性22例女性19例,年龄(71.5±4.4)岁。完善NT-proBNP及动态心电图等相关检查。结果心衰组的尿酸(385.5±93.4)mmol/L、NT-proBNP(2 294.9±626.2)高于对照组(308.4±89.5)mmol/L、(196.2±59.9),差异有统计学意义(P<0.05);心衰组的正常RR间期标准差(SDNN)[(88.9±15.0)比(140.4±17.9)]、5 min均值标准差(SDANN)[(77.2±13.6)比(127.5±12.7)]、全程相邻RR间期之差的平方根(RMSSD)[(21.6±4.6)比(36.6±10.2)]、相邻RR间期相差>50 ms的个数占总心跳数的百分比(PNN50)[(6.4±2.3)比(17.5±6.2)]低于对照组,差异有统计学意义(P<0.05);随着心功能减退,SDNN、SDANN、RMSSD、PNN50逐渐降低,NT-proBNP逐渐升高。NT-proBNP与SDNN、SDANN、RMSSD、PNN50呈负相关(r=-0.854,P<0.01;r=-0.876,P<0.01;r=-0.737,P<0.01;r=-0.698,P<0.01)。结论 NT-proBNP与HRV的相关指标均能反映心力衰竭,随着心力衰竭加重NT-proBNP逐渐增高,而HRV的相关指标逐渐降低,NT-proBNP与HRV的相关指标呈负相关。

Objective To investigate the correlation between heart rate variability(HRV)and plasma N-terminal probrain natriuretic peptide(NT-proBNP)in elderly heart failure with left ventricular ejection fraction preserved(HFpEF),and to provide reference for the diagnosis of HFpEF.Methods A total of 98 chronic heart failure(CHF)elderly patients who were hospitalized in Langzhong People’s Hospital from January 2014 to May 2017 were selected as CHF group,there were 54 male and 44 female patients,the average age of the patients was(70.0±6.3)years.According to the American Heart Association New York heart function NYHA grade,they were assigned into three groups including group Ⅱ of cardiac function,group III of cardiac function,group Ⅳ of cardiac function.41 cases of heart failure in elderly patients without CHF hospitalized during the same period were selected as control group,there were 22 male and 19 female patients,the average age was(71.5±4.4)years.All people should do NT-proBNP and dynamic electrocardiogram examination.Results The uric acid[(385.5±93.4)mmol/L vs.(308.4±89.5)mmol/L],NT-proBNP[(2 294.9±626.2)vs.(196.2±59.9)]in CHF group were higher than those in the control group,and the difference was statistically significant(P<0.05).SDNN[(88.9±15.0)vs.(140.4±17.9)],SDANN[(77.2±13.6)vs.(127.5±12.7)],RMSSD[(21.6±4.6)vs.(36.6±10.2)]and PNN50[(6.4±2.3)vs.(17.5±6.2)]in CHF group were lower than those in the control group,and the difference was statistically significant(P<0.05).With the decrease of cardiac function,SDNN,SDANN,RMSSD and PNN50 gradually decreased,while NT-proBNP gradually increased.Nt-probnp was negatively correlated with SDNN,SDANN,RMSSD and PNN50(r=-0.854,P<0.01;r=0.876,P<0.01;r=0.737,P<0.01;r=-0.698,P<0.01).Conclusion The related indicators of NT-proBNP and HRV can reflect heart failure.With the increase of the heart failure,NT-proBNP gradually increases,while the relevant indicators of HRV gradually decrease,and the related indicators of NT-proBNP and HRV are negatively correlated.