基于动态心电图检查评估原发性甲亢患者心脏自主神经功能状态

Evaluation of Cardiac Autonomic Nerve Function in Patients with Primary Hyperthyroidism in Terms of Dynamic Electrocardiogram

【目的】基于动态心电图检查讨论原发性甲亢患者心脏自主神经功能状态。【方法】选取2018年1月至2019年12月本院收治的44例原发性甲亢患者(观察组),选取同期体检的健康者44例为对照组。比较两组心率变异性指标及心脏变时功能指标,并分析观察组患者变时功能指标与心率变异性指标的相关性。【结果】观察组患者正常RR间期的标准差(SDNN)、RR间期平均值标准差的平均值(SDANN)、RR间期标准差的平均值(SDNN Idx)、相邻RR间期差值的均方根(rMSSD)、相邻RR之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)、三角指数明显低于对照组,差异均有统计学意义(均P<0.05)。观察组患者最慢心率、24 h平均心率、日间平均心率、夜间平均心率及非杓型心率发生率均高于对照组,最快与最慢心率之差低于对照组,差异均有统计学意义(均P<0.05)。甲亢患者最慢心率、24 h平均心率、夜间平均心率与SDNN、SDANN、rMSSD及三角指数存在显著相关性(均P<0.05),最快与最慢心率之差与SDNN、三角指数存在显著相关性(均P<0.05),日间平均心率与SDNN、rMSSD及三角指数存在显著相关性(均P<0.05)。【结论】甲亢患者显著存在心脏自主神经系统调节失衡,表现为交感神经和迷走神经双重受损,其中交感神经过度激活更为严重。

【Objective】Evaluation of cardiac autonomic nerve function in patients with primary hyperthyroidism in terms of dynamic electrocardiogram.【Methods】A total of 44 patients with primary hyperthyroidism admitted to Jiangsu Hospital of Traditional Chinese Medicine from January 2018 to December 2019 were selected as the observation group,while 44 people matched with age and sex at the same period were selected as the control group.The changes of heart rate(HR)variability(SDNN,SDNN Idx,PNN50,rMSSD,SDANN,triangle index);cardiac chronological function indexes(maximum HR,minimal HR,difference between the maximum and minimal HR,24-hour average HR,daytime average HR,nocturnal average HR and circadian rhythm of HR)were compared in the two groups,and the correlation between chronological function indexes and heart rate variability(HRV)indexes was analyzed in the observation group.【Results】(1)The time-domain indexes of HRV including SDNN,SDNN Idx,PNN50,rMSSD,SDANN and triangle index in the observation group were significantly lower than those in the control group(P<0.05).(2)There was no significant difference in the maximum HR between two groups(P=0.138),however,minimal HR and difference between the maximum and minimal HR in the observation group were higher than those in the control group(P<0.001,P=0.004).24-hour average HR,average daytime HR and average nighttime HR in the observation group were higher than those in the control group(P<0.05).(3)In the observation group,all the chronotropic functional indexes except for maximum HR were mainly correlated with SDNN and triangle index.SDNN was negatively correlated with minimal HR(r=-0.771)and with nocturnal average HR(r=-0.790),while the triangle index was negatively correlated with minimal HR(r=-0.729)and nocturnal average HR(r=-0.770).The slowest heart rate,24-hour average heart rate,night average heart rate of patients with hyperthyroidism were significantly correlated with SDNN,SDANN,rMSSD and triangular index(all P<0.05),and the difference between the fastest and slowest heart rate was significantly correlated with SDNN and triangular index(All P<0.05),there was a significant correlation between the average daytime heart rate and SDNN,rMSSD and triangle index(all P<0.05).【Conclusion】There is a significant imbalance in the regulation of cardiac autonomic nerve system in patients with hyperthyroidism,which is characterized by double damage of sympathetic nerve and vagus nerve,in which the over activation of sympathetic nerve is more serious.