慢性肾功能衰竭与心率变异性时域分析的相关性研究

目的 :评价慢性肾功能衰竭患者自主神经损伤及其相关因素。方法 :选择肾内科住院患者及健康体检人员共 40例 ,按肾功能水平分为正常对照组、肾功能正常组、氮质血症组和尿毒症组 ,分别检测患者心率变异性 (HRV )时域指标并同步监测患者动态血压 ,进行显著性差异检验。 结果 :(1)尿毒症组 HRV时域指标中主要观察指标显著低于其余各组 (P<0 .0 1或P<0 .0 5 ) ,而其余各组间 HRV时域指标均无显著性差异 ;(2 )尿毒症肾性高血压患者 HRV时域指标显著低于尿毒症正常血压患者 (P<0 .0 5 )。 结论 :(1)随着慢性肾功能衰竭病程进展 ,患者逐步出现心脏自主神经系统损害及功能失调 ;(2 )慢性肾功能衰竭患者心脏自主神经系统损害与肾功能水平呈正相关 ;尿毒症本身即为心脏自主神经系统损害的独立因素。 (3)尿毒症肾性高血压将加重患者心脏自主神经系统损害

Study on the interrelationship between time domain analysis of heart rate variab ility and chronic renal failure

Objective: To assess the autonomic nervous impairment in chronic renal failure and its related factors. Methods: Forty adults were randomly selected including in patients in the nephrology ward and healthy subjects for routine medical examination. The subjects were classified into 4 groups: normal subjects(NS),normal renal function,nitremia, uremic patients. The time domain measurements of heart rate variability(HRV) and ambulatory blood pressure were analyzed simultaneously . Results: (1) There were significant differences as compared with normal subjects in the time domain measurements of HRV in uremic group. It decreased significantly when the patient was defined as end stage chronic renal failure. There were no significant differences between NS,normal renal function group and nitremic group. (2) Time domain measurements of HRV was significantly lower( P <0.05) in uremia with renal hypertension than in uremia with normal blood pressure. Conclusion: (1) Patients with chronic renal failure(HRV) have their cardiac autonomic nervous system impaired conspicuously in the course of uremia. (2) There is a positive correlation between cardiac autonomic nervous system impairment in patients with CRF and renal function levels. Uremia itself is an independent factor for the impairment of cardiac autonomic nervous system. (3) Renal hypertension with uremia may intensify the impairment of cardiac autonomic nervous system of the patients.