冠心病合并充血性心力衰竭患者心率变异、甲状腺激素水平及其与病情的相关性

Heart rate variability and changes in thyroid hormone level of patients with coronary heart disease and congestive heart failure and their correlation with the condition

目的研究冠心病(CHD)合并充血性心力衰竭(CHF)患者心率变异、甲状腺激素水平变化及其与病情的相关性。方法选取本院2018年4月~2020年2月收治且经DSA确诊的CHD合并CHF患者72例(CHF组)及未合并CHF患者62例(CHD组)作为研究对象。同期选取行健康体检者作为对照组(n=50)。比较3组心率变异性指标[R-R间期标准差(SDNN)、24 h相邻R-R间期标准差的均方根(rMSSD)、低频(LF)、高频(HF)]与甲状腺激素水平[血清三碘甲状腺原氨酸(T_(3))、甲状腺素(T_(4))、促甲状腺素(TSH)]。分析CHF组患者甲状腺激素水平变化与心率变异性指标间的相关性,并探讨心功能分级与甲状腺激素水平、心率变异性指标的相关性。结果与对照组比较,CHD组、CHF组SDNN、rMSSD、LF、HF明显降低,LF/HF则升高,以CHF组降低最为明显(P<0.05)。与对照组、CHD组比较,CHF组血清T_(3)水平明显降低(P<0.05);且患者心功能分级越高,SDNN、rMSSD、LF、HF、LF/HF及T_(3)水平指标水平随之下降(P<0.05)。心功能Ⅳ级T_(4)水平显著低于Ⅱ级(P<0.05)。进一步相关性分结果显示,CHD合并CHF患者心功能分级与心率变异性指标及T_(3)呈负相关(P<0.05),与T_(4)及TSH无明显相关性(P>0.05);心率变异性指标与T_(3)呈正相关(P<0.05)。结论CHD合并CHF老年患者伴有心率变异性、血清T 3水平降低,且血清T_(3)水平下降程度与心衰程度具有一定相关性,两者可作为评估其病情严重程度的重要指标。

Objective To study heart rate variability and change in thyroid hormone level of patients with coronary heart disease(CHD)and congestive heart failure(CHF)and their correlation with the condition.Methods 72 CHD patients with CHF(CHF group)/62 CHD patients without CHF(CHD group)admitted to our hospital from April 2018 to February 2020 and were diagnosed by DSA were selected as the research object.At the same time,people with physical examination were selected as the control group(n=50).The indexes of heart rate variability[standard deviation of NN interval(SDNN),24h adjacent root mean square of standard deviation of RR interval(rMSSD),low frequency(LF),high frequency(HF)]and thyroid hormone levels[serum triiodothyronine(T_(3)),thyroxine(T_(4)),and thyrotropin(TSH)]were compared among the three groups.The correlation between changes in thyroid hormone levels and indexes of heart rate variability in patients with coronary heart disease and CHF was analyzed.The correlation between cardiac function grading,thyroid hormone level and index of heart rate variability was also discussed.Results Compared with those in the control group,the SDNN,rMSSD,LF,HF of the CHD group and CHF group significantly reduced,and the LF/HF increased.The decreasing was the most obvious in the CHF group(P<0.05).Compared with that in the control group and the CHD group,the serum T_(3)level of the CHF group significantly reduced(P<0.05).The higher the grade of cardiac function was,the lower the SDNN,rMSSD,LF,HF,LF/HF and T_(3)levels were(P<0.05).The T_(4)level of patients in cardiac function gradeⅣwas significantly lower than that of patients in gradeⅡ(P<0.05).The results of further correlation analysis showed that:the classification of heart function in patients with coronary heart disease and CHF was negatively correlated with index of heart rate variability and T_(3)(P<0.05),and there was no significant correlation with T_(4)and TSH(P>0.05).Cardiac function grading was negatively correlated with the index of heart rate variability and T_(3)(P<0.05),and had no significant correlation with T_(4)and TSH(P>0.05).The heart rate variability index was positively correlated with T_(3)(P<0.05).Conclusion Elderly patients with CHD and CHF are accompanied by heart rate variability and decreasing of serum T_(3)levels.The degree of decreasing in serum T_(3)level has some correlation with the degree of heart failure,and they can be used as the important indicator to assess the severity of their disease.