不稳定型心绞痛患者冠状动脉病变严重程度与窦性心率震荡相关性

Correlation between severity of coronary artery lesions and heart rate turbulence in patients with unstable angina pectoris

目的 探讨不稳定型心绞痛(UAP)患者窦性心率震荡现象(HRT)与冠状动脉(冠脉病变严重程度的相关性及对UAP的诊断价值。方法 本研究为回顾性观察性研究,连续纳入自2019年8月至2021年4月于武汉大学人民医院心血管内科住院UAP患者和冠脉粥样硬化患者,术前完善24 h动态心电图HRT的参数[震荡斜率(TS)、震荡初始(TO)],并于住院期间行冠脉造影,根据冠脉造影结果将其分为UAP组和冠脉硬化组。基于Gensini评分评估UAP患者冠脉病变严重程度与HRT的相关性。使用ROC曲线评估HRT对UAP患者的诊断价值。采用多重Logistic回归的统计方法分析HRT与UAP患者的关系。应用多因素线性回归分析HRT与冠脉病变严重程度之间的关系。结果 共入选198例患者。(1)在单因素分析中,UAP组的TO指标高于冠脉硬化组,而TS指标低于冠脉硬化组(P<0.05),在多因素Logistic回归分析中,TO(OR=1.229,95%CI:1.030~1.468,P=0.022)和TS(OR=0.843,95%CI:0.757~0.939,P=0.002)是不稳定型心绞痛患者的独立影响因素(P<0.05)。(2)多因素线性回归分析显示,TO(B=3.136,P=0.015)、TS(B=-1.439,P=0.045)均是患者的Gensini评分影响因素。(3)ROC曲线分析显示,TO、TS对UAP患者均有一定的预测能力(P<0.05)。结论 HRT是UAP患者的独立影响因素,有助于鉴别UAP患者,且在UAP患者中,HRT是冠脉病变程度的影响因素。

Objective To discuss the correlation between severity of coronary artery lesions and heart rate turbulence(HRT)in patients with unstable angina pectoris(UAP),and diagnostic value of HRT to UAP.Methods UAP patients and patients with coronary artery atherosclerosis(CAAS)were chosen in this retrospective and observation study from Department of Cardiovascular Medicine in Renmin Hospital of Wuhan University from Aug.2019 to Apr.2021.The preoperative parameters of 24-h Holter HRT were perfected,including turbulence slope(TS)and turbulence onset(TO),and all patients were given examination of coronary angiography(CAG)and divided,according to CAG results,into UAP group and CAAS group.The correlation between severity of coronary artery lesions and HRT was reviewed based on Gensini scoring.The diagnostic value of HRT to UAP patients was reviewed by using ROC curve.The relationship between HRT and UAP patients was analyzed by using multi-factor Logistic regression analysis.The relationship between HRT and severity of coronary artery lesions was analyzed by using multiple linear regression analysis.Results There were totally 198 patients included.The results of single-factor analysis showed that TO was higher and TS lower in UAP group than those in CAAS group(P<0.05).The results of multi-factor Logistic regression analysis showed that TO(OR=1.229,95%CI:1.030~1.468,P=0.022)and TS(OR=0.843,95%CI:0.757~0.939,P=0.002)were independent influence factors in UAP patients(P<0.05).②The results of multiple linear regression analysis showed that TO(B=3.136;P=0.015)and TS(B=-1.439,P=0.045)were influence factors of Gensini scoring.③The results of ROC curve analysis showed that TO and TS had some predictive ability in UAP patients(P<O.05).Conclusions HRT is an independent influence factor and can help to distinguish UAP patients,and HRT is an influence factor of severity of coronary artery lesions in UAP patients.