难治性心绞痛的心率变异性表达及其预后研究

Expression of heart rate variability and its prognosis in refractory angina pectoris

目的分析难治性心绞痛(refractory angina pectoris,RFA)患者心率变异性(heart rate variability,HRV)变化特点,探讨HRV对患者预后的预测价值。方法选取难治性心绞痛患者60例,并以同期非难治性心绞痛患者60例作为对照组,分析两组间HRV指标,包括全部窦性心搏RR间期标准差(SDNN)、24h每5minRR间期均值标准差(SDANN)、相邻RR间期差值的均方根(rMSSD)、相邻RR间期差值>50ms的心搏数占全部心搏数的百分比(PNN50)、极低频功率(very lowfrequency power,VLF)、低频功率(lowfrequency power,LF)和高频功率(highfrequency power,HF)、低频与高频功率比值(LF/HF),通过二元Logistic回归分析校正难治性心绞痛的危险因素。记录两组患者出院后1年内主要不良心血管事件(major adverse cardiac events,MACE)发生情况,根据是否发生MACE将难治性心绞痛组分为MACE和非MACE两个亚组,分析并比较两亚组间患者的HRV和相关危险因素。结果难治性心绞痛组HRV指标SDNN、SDANN、rMSSD、PNN50、VLF、LF、HF显著低于非难治性心绞痛组(P<0.05),校正后rMSSD、PNN50、LF仍显著降低(P<0.05)。难治性心绞痛患者MACE与非MACE组比较,MACE组HRV指标SDNN、SDANN、VLF显著降低(P<0.05),校正后两亚组间SDNN、SDANN差异有统计学意义(P<0.05)。结论难治性心绞痛患者HRV降低,HRV下调是难治性心绞痛发生MACE的预测因子。

Objective To characteristics of heart rate variability(HRV)in patients with refractory angina pectoris(RFA)were analyzed to discuss the predictive value of HRV for patients’prognosis.Methods Sixty patients with refractory angina pectoris and 60 patients with non-refractory angina pectoris during the same period were selected as the control group to analyze the HRV index between the two groups.The results included the standard deviation of RR interval of all sinus heartbeats(SDNN),the mean standard deviation of RR interval per 5 min.24h(SDANN),the root mean square of adjacent RR interval difference(rMSSD),the percentage of adjacent RR interval difference>50ms in total heart beats(PNN50),very low frequency power(VLF),low frequency power(LF)and high frequency power(HF),low frequency and high frequency power ratio(LF/HF),and the risk factors of refractory angina pectoris were corrected by binary logistic regression analysis.The occurrence of major adverse cardiac events(MACE)was recorded in both groups within one year after discharge.The refractory angina group was divided into MACE and non-MACE subgroups according to the occurrence of MACE.The HRV and related risk factors between the two subgroups were analyzed and compared.Results The HRV indexes SDNN,SDANN,rMSSD,PNN50,VLF,LF and HF in refractory angina group were significantly lower than those in non-refractory angina group(P<0.05),and rMSSD,PNN50 and LF were still decreased after correction(P<0.05).The HRV indexes SDNN,SDANN and VLF in refractory angina were significantly decreased in MACE group(P<0.05),and there were still significant differences in SDNN and SDANN between the two groups after correction(P<0.05).Conclusion HRV is decreased in patients with refractory angina,and downregulation of HRV is a predictor of MACE in refractory angina.