内源性促红细胞生成素对冠心病患者心电参数昼夜调节的作用研究

Effect of EPO on diurnal regulation of ECG parameters in patients with coronary heart disease

目的探讨内源性促红细胞生成素(EPO)对冠心病患者心电参数昼夜调节的作用。方法收集196例因疑诊冠心病而行冠脉造影术的患者为研究对象,根据造影结果,将患者分为冠心病组97例、非冠心病组99例。收集患者基线资料及实验室检查结果,并行动态心电图检查。根据EPO检测结果,将冠心病组患者进一步分为低EPO组、中EPO组及高EPO组,统计分析EPO对心电参数昼夜调节的影响。结果(1)EPO水平与所有患者(r=0.291,P=0.000)、冠心病患者(r=0.432,P=0.000)的红细胞分布宽度(RDW)水平呈明显正相关关系。(2)与非冠心病患者相比,冠心病组患者的昼夜校正Q-T间期(QTc)差值显著较小,夜间QTc及昼夜的全部窦性心搏RR间期的标准差(SDNN)、相邻RR间期差值的平方根(RMSSD)、相邻心动周期差>50 ms的次数占总心跳次数的百分比(PNN50)值均显著较小(P<0.05)。(3)3组不同EPO水平患者的昼夜QTc差值、夜间QTc、昼夜SDNN、RMSSD、PNN50值差异均具有统计学意义(P<0.05)。两两比较后发现,与低EPO组相比,中EPO组与高EPO组的昼夜SDNN、RMSSD、PNN50值明显较低(P<0.05),且高EPO组的昼夜QTc差值及夜间QTc显著更高(P<0.05)。(4)EPO水平与冠心病患者的昼夜QTc差值、昼夜SDNN、昼夜RMSDD、昼夜PNN50均呈负相关,但与昼夜SDNN、夜间QTc无明显相关性。结论冠心病患者心率变异性昼夜节律不明显,且心电参数与EPO水平存在显著的负相关关系。

Objective To investigate the effect of endogenous erythropoietin(EPO)on the circadian regulation of electrocardiographic parameters in patients with coronary heart disease.Methods 196 patients with suspected coronary heart disease who underwent coronary angiography were studied.According to the results of angiography,the patients were divided into coronary heart disease group(97 cases)and non-coronary heart disease group(99 cases).The baseline data and laboratory test results of patients were collected,and dynamic ECG was performed.According to the results of EPO,the patients in coronary heart disease group were further divided into three groups:low EPO group,medium EPO group and high EPO group.The effect of EPO on the circadian regulation of ECG parameters was analyzed.Results(1)EPO level was positively correlated with the red blood cell distribution width(RDW)in all patients(r=0.291,P=0.000)and coronary heart disease(r=0.432,P=0.000).(2)Compared with non-coronary heart disease patients,the difference of QTc in coronary heart disease group was significantly smaller,standard deviation of NN intervals(SDNN),the square root of the mean of the squares of successive RR interval differences(RMSSD),percentage of differences between adjacent normal RR intervals exceeding 50 milliseconds(pNN50)were significantly smaller(P<0.05).(3)The difference of day and night QTc,night QTc,day and night SDNN,RMSSD,PNN50 in the three groups with different levels were statistically significant(P<0.05).The pairwise comparison showed that the diurnal SDNN,RMSSDand PNN50 values were significantly lower in the middle EPO group compared with the high EPO group(P<0.05),and the diurnal QTc difference and nocturnal QTc in the high EPO group were significantly higher(P<0.05).(4)EPO levels were negatively correlated with diurnal QTc difference,diurnal SDNN anddiurnal PNN50,but not with diurnal and nocturnal QTc in patients with coronary heart disease.Conclusion The circadian rhythm of heart rate variability in coronary heart disease patients is not obvious,and there is a significant negative correlation between ECG parameters and EPO level.