从Lorenz散点图角度分析缓慢性心律失常不同中医证型的心率变异性

Analysis of Heart Rate Variability in Bradycardia Patients with Different Traditional Chinese Medicine Syndromes from the Perspective of Lorenz Scatter Plot

【目的】比较缓慢性心律失常不同中医证型时域指标和Lorenz散点图指标的差异,并探究时域指标和Lorenz散点图指标的相关性。【方法】采用回顾性研究方法,收集104例缓慢性心律失常患者的临床资料,根据中医辨证分型分为心阳不振证39例、心血瘀阻证39例、气阴两虚证26例,分析不同中医证型缓慢性心律失常患者的时域指标[全部正常窦性心搏NN间期的标准差(SDNN)、全程每5 min的NN间期平均值的标准差(SDANN)、全程相邻NN间期之差的均方根值(rMSSD)、相邻NN间期之差大于50 ms的心搏数的百分比(PNN50)]和Lorenz散点图指标(长度、离散度)的差异。【结果】(1)Lorenz散点图:气阴两虚证的散点图长度明显低于其他2组证型(P<0.05或P<0.01),气阴两虚证的散点图离散度明显低于心阳不振证(P<0.01)。(2)时域指标:气阴两虚证的SDNN、SDANN、PNN50、rMSSD均明显低于心阳不振证(P<0.05或P<0.01)。(3)Lorenz散点图与时域指标的相关性:经Pearson相关性分析,散点图的长度与SDNN、SDANN、PNN50均呈显著正相关(P<0.05),散点图的离散度与PNN50呈显著正相关(P<0.05)。【结论】缓慢性心律失常不同中医证型之间的心率变异性存在差异。

Objective To compare the differences in the time-domain indices and Lorenz scatter plot indices of bradycardia patients with different traditional Chinese medicine(TCM)syndrome types,and to investigate the correlation between the time-domain indices and Lorenz scatter plot indices.Methods The clinical data of 104patients with bradycardia were collected using the method of retrospective study.The enrolled patients were differentiated as decline of heart yang syndrome(39 cases),heart blood obstruction syndrome(39 cases),and qiyin deficiency syndrome(26 cases).And then we analyzed the differences in the time-domain indexes[standard deviation of the average normal-to-normal intervals(SDNN),standard deviation of the average normal-to-normal intervals in every 5 minutes(SDANN),root mean square of the successive differences(rMSSD),and percentage of normal waves differing≥50 ms compared to the preceding wave(PNN50)]and in the Lorenz scatter plot indicators(length and dispersion)of bradycardia patients with various TCM syndrome types.Results(1)The length of the Lorenz scatter plot for qi-yin deficiency syndrome was significantly lower than that of the other2 syndrome types(P<0.05 or P<0.01),and the dispersion of the scatter plot for qi-yin deficiency syndrome was significantly lower than that of decline of heart yang syndrome(P<0.01).(2)The time-domain indicators of SDNN,SDANN,PNN50 and rMSSD were all significantly lower in patients with qi-yin deficiency syndrome than those with decline of heart yang syndrome(P<0.05 or P<0.01).(3)The Pearson correlation analysis showed that the length of the scatter plot was positively correlated with SDNN,SDANN and PNN50(P<0.05),and the dispersion of the scatter plot was positively correlated with PNN50(P<0.05).Conclusion There exist differences in heart rate variability of bradycardia patients with various TCM syndrome types.