BPV、HRV与原发性高血压合并STEMI患者发生急性肾损伤的相关性分析

Correlation Analysis of BPV,Heart Rate Variability and Acute Kidney Injury in Patients with Essential Hypertension and STEMI

【目的】探讨血压变异性(BPV)、心率变异性(HRV)与原发性高血压合并ST段抬高型心肌梗死(STEMI)患者发生急性肾损伤(AKI)的相关性。【方法】选取本院确诊的100例原发性高血压合并STEMI患者作为研究对象,根据患者住院治疗期间是否发生AKI将其分为AKI组(n=23)和非AKI组(未发生AKI,n=77)。比较两组患者的24 h收缩压变异性(24hSBPV)、24 h舒张压变异性(24hDBPV)、24 h正常心电图RR间期标准差(SDNN)、24 h相邻RR间期差值>50 ms的计数占总RR间期数的百分比(PMN50),采用Logistic回归分析法探讨BPV、HRV与原发性高血压合并STEMI患者发生AKI的相关性。【结果】AKI组患者的年龄、性别、BMI、吸烟、饮酒、糖尿病、血脂异常与非AKI组比较,差异均无统计学意义(P>0.05);AKI组患者入院时SCr水平、患者起病至急诊时间均高于非AKI组(P<0.05)。AKI组患者24hSBPV、24hDBPV均高于非AKI组,AKI组患者的SDNN、PMN50均低于非AKI组,差异均有统计学意义(均P<0.05)。入院时SCr水平、24hSBPV、24hDBPV升高,患者起病至急诊时间延长是原发性高血压合并STEMI患者发生AKI的独立危险因素(P<0.05);SDNN、PMN50与原发性高血压合并STEMI患者是否发生AKI无相关性(P>0.05)。【结论】原发性高血压合并STEMI患者BPV增大可能会导致患者发生AKI,对于这部分患者需早期加强监测,并给予积极干预。

【Objective】To investigate the relationship between blood pressure variability(BPV),heart rate variability(HRV)and acute kidney injury(AKI)in patients with essential hypertension and ST segment elevation myocardial infarction(STEMI).【Methods】A total of 100 patients with primary hypertension complicated with STEMI in our hospital were selected as the research objects,and they were divided into AKI group(n=23)and non AKI group(n=77)according to whether AKI occurred during hospitalization.The 24 h systolic blood pressure variability(24hSBPR),24 h diastolic blood pressure variability(24hDBPV),standard deviation of 24 h normal ECG RR interval(SDNN)and percentage of 24 h adjacent RR interval difference>50 ms in total RR interval(PMN50)were compared between the two groups.The correlation between BPV,heart rate variability and AKI in patients with essential hypertension and STEMI was analyzed by logistic regression analysis.【Results】There was no significant difference in age,gender,BMI,smoking,drinking,diabetes and dyslipidemia between the group AKI and the non AKI group(P>0.05).The SCR level at admission and the time from onset to emergency in the AKI group were higher than those in the non AKI group(P<0.05).The 24hSBPV and 24hDBPV of the AKI group were higher than those of the non AKI group,and the SDNN and PMN50 of the AKI group were lower than those of the non AKI group,the differences were statistically significant(mean P<0.05).The increase of SCR level,24hSBPV and 24hDBPV at admission,and the prolonged time from onset to emergency were the independent risk factors for AKI in patients with essential hypertension and STEMI(P<0.05);There was no correlation between SDNN,PMN50 and AKI in essential hypertension patients with STEMI(P>0.05).【Conclusion】The increase of BPV in patients with essential hypertension and STEMI may lead to AKI.Early monitoring and active intervention are needed for these patients.