慢性肾衰竭患者自主神经损伤及其临床相关因素研究

Research on the autonomic nerve injury conditions and its clinical influence factors for patients with chronic renal failure

目的研究慢性肾衰竭患者自主神经损伤情况及临床相关因素。方法选取本院2014年5月至2016年5月收治的慢性肾衰竭患者90例作为研究对象,按患者肾功能水平进行分组,其中肾功能正常-代偿(normal renal function)患者30例,氮质血症(ni-tremia)患者30例,尿毒症(uremia)患者30例。另选取同期来本院进行体检的50名健康者作为对照组。对所有研究对象进行心率变异性(HRV)时域指标检测并同步检测动态血压。结果对照组SDNN、SDANN、Triangular index水平分别为(115.2±22.3)ms、(108.3±24.5)ms、(512.4±134.8)ms;肾功能正常-代偿组分别为(114.9±25.4)ms、(110.6±29.2)ms、(531.5±154.3)ms;氮质血症组分别为(110.6±28.2)ms、(113.4±26.9)ms、(528.9±196.2)ms,均高于尿毒症组(69.4±22.1)ms、(65.8±19.6)ms以及(323.7±119.5)ms(F=26.56、24.81、13.65,P<0.05);对照组SDNN index水平(54.3±10.8)ms,均高于肾功能正常-代偿组(43.7±12.5)ms、氮质血症组(43.2±12.6)ms以及尿毒症组(39.3±11.6)ms(F=12.47,P<0.05);而各组RMSSD比较差异无统计学意义(F=0.577,P>0.05)。尿毒症肾性高血压患者SDNN、SDANN index、SDNN index以及Triangular index均低于尿毒症血压正常患者(t=5.116、3.889、3.413、4.173,P<0.05)。结论随着慢性肾功能衰竭病情的进展,患者心脏自主神经系统损害明显加重,尤其是进展为终末期尿毒症的患者各项心脏自主神经系统功能降低更明显。尿毒症肾性高血压患者心脏自主神经系统损害更严重。

Objective To explore the autonomic nerve injury conditions and its clinical influence factors for patients with chronic renal failure.Methods 90 patients with chronic renal failure treated from May 2014 to May 2016 in our hospital were selected. They were divided into normal renal function group, Ni-tremia group and Uremia group according to the renal function, with 30 cases in each group. In addition, 50 healthy checkups were selected as control group. The HRV(heart rate variability) and the ambulatory blood pressure were detected. Results The SDNN,SDANN index and Triangular index for normal renal function group, Ni-tremia group and control group were significantly higher than those of Uremia group(F=26.56, 24.81, 13.65, P<0.05). The SDNN index for control group was significantly higher than that of normal renal function group,Ni-tremia group and Uremia group(F=12.47, P<0.05). The index of RMSSD for each group was not significantly different(F=0.577, P>0.05). The SDNN index, SDANN index, SDNN index and Triangular index for renal hypertension patients were significantly lower than those of normal blood pressure patients(t=5.116, 3.889, 3.413, 4.173, P<0.05). Conclusion With the progression of chronic renal failure, the autonomic nerve injury is exacerbated, especially for the advanced Uremia patients and the renal hypertension patients.