高血压颈动脉粥样硬化患者动态心电图变化及其与缺血性脑卒中的关系

Changes of dynamic electrocardiogram in hypertensive carotid atherosclerosis and its relationship with ischemic stroke

目的探究高血压颈动脉粥样硬化患者的动态心电图变化及其与缺血性脑卒中的关系。方法将2018年7月至2020年3月在西电集团医院就诊的110例高血压患者根据颈动脉内-中膜厚度(IMT)分为两组,A组(IMT≥1.0 mm,87例)含不同类型斑块(无斑块组24例,稳定性斑块组43例,不稳定性斑块组20例)及B组(IMT<1.0 mm,23例)。比较两组患者及A组内不同类型斑块患者的动态心电图变化[心率减速率(DC)、总体标准差(SDNN)、差值方根值(rMSSD)及低频功率/高频功率(LF/HF)]和缺血性脑卒中的发生情况。结果A组患者的DC、SDNN、rMSSD及LF/HF值分别为(5.57±1.32)ms、(96.39±10.90)ms、(22.85±4.02)ms、5.41±1.29,明显低于B组的(6.34±1.65)ms、(110.30±9.05)ms、(24.76±4.31)ms、6.46±1.57,差异均具有统计学意义(P<0.05);稳定性斑块组及不稳定性斑块组患者的DC、SDNN、rMSSD及LF/HF值明显低于无斑块组,不稳定性斑块组患者的DC、SDNN、rMSSD及LF/HF值明显低于稳定性斑块组,差异均具有统计学意义(P<0.05);B组患者中没有出现缺血性脑卒中(0),A组患者中出现缺血性脑卒中16例(18.39%),差异具有统计学意义(P<0.05)。结论与单纯高血压患者相比,高血压颈动脉粥样硬化患者心电图变化较为异常,其自主神经功能损伤随着硬化斑块的形成进一步加剧,病变原因可能与其缺血性脑卒中的发生风险增加有关。

Objective To explore the changes of dynamic electrocardiogram in patients with hypertensive carotid atherosclerosis and its relationship with ischemic stroke.Methods According to carotid intima-media thickness(IMT),110 hypertensive patients admitted to Xi'an XD Group Hospital from July 2018 to March 2020 were divided into group A(IMT≥1.0 mm,87 cases)with different types of plaques(24 cases in spotless group,43 cases in stable plaque group,20 cases in unstable plaque group)and group B(IMT<1.0 mm,23 cases).The electrocardiogram changes[heart rate reduction rate(DC),overall standard deviation(SDNN),difference root value(rMSSD),and low frequency power/high frequency power(LF/HF)]and the incidence of stroke were compared between the two groups and different types of plaques in group A.Results The values of DC,SDNN,rMSSD,and LF/HF in group A were(5.57±1.32)ms,(96.39±10.90)ms,(22.85±4.02)ms,5.41±1.29,significantly lower than(6.34±1.65)ms,(110.30±9.05)ms,(24.76±4.31)ms,6.46±1.57 in group B(P<0.05).In patients with hypertension and carotid atherosclerosis,DC,SDNN,RMSSD,and LF/HF values of stable plaque group and unstable plaque group were significantly lower than those in spotless group,and those in unstable plaque group were significantly lower than those in stable plaque group,all with statistically significant differences(P<0.05).There were 0 case of ischemic stroke in group B(with the incidence of 0)and 16 cases of ischemic stroke in group A(18.39%),and the difference was statistically significant in the incidence between the two groups(P<0.05).Conclusion Compared with patients with simple hypertension,the changes of electrocardiogram in patients with hypertensive carotid atherosclerosis were abnormal,and the damage of autonomic nerve function was further aggravated with the formation and development of atherosclerotic plaques,which may be related to the increased risk of ischemic stroke.