左心室功能、质量及几何构型对高血压患者自主神经功能的影响

目的 探讨高血压患者不同左心室功能、质量、几何构型心率变异性(HRV)指标的差别及对自主神经调节的影响。方法将300例高血压患者分别分为收缩功能不全与正常组;舒张功能异常与正常组;左心室肥厚(LVH)与正常组及几何构型正常和异常组,后者包括向心性重构、离心性肥厚和向心性肥厚三个亚组,分别比较各对应组间HRV指标的差别,并对左心室射血分数(LVEF)、二尖瓣血流频谱E峰、A峰比值(E/A)、左心室质量指数(LVMI)、相对室壁厚度(RWT)与HRV各指标间的相关性进行了分析。结果 左心室收缩功能不全组与正常组间HRV各项指标无显著性差异,舒张功能异常组HRV各项指标均显著低于正常组,LVH组部分指标正常窦性心搏间期的标准差(SDNN)、5min连续时间段标准差的平均值(SDNNI)、低频功率(LF)和高频功率(HF)]明显低于正常组,除相邻正常窦性心搏间期(NN)间期差的均方根(rMMSD)和NN间期差大于50ms心搏与总NN间期的百分比(PNN50)外,3个几何构型异常组HRV各项指标均明显低于正常组,但各异常组间无显著性差异。单变量回归分析提示RWT、LVMI、LVEF与HRV主要指标存在显著的相关性,E/A与HRV各项指标均显著相关。多变量分析提示RWT与SDNN、LVMI与SDANN、LVEF与SDNN、E/A与LF独立相关。结论 左心室功能损害、LVH及几何构型异常可影

Influence of left ventricular function,mass and geometric patterns on autonomic nerve function in hypertensive patiens

Objective To evaluate differences of heart rare variability (HRV) between disparity left ventricular function, mass and geometric patterns,and effects of left ventricular function,mass and geometric patterns on regulation of autonomic nerve function in hypertensive patients. Methods Three hundred hypertensive patients were divided into the four correspondence groups respectively, which involved systolic disfunction and normal group;dias-tolic abnormal function and normal group; left ventricular hypertrophy(LVH) and normal group; abnormal geometric patterns and normal groups, the former subdivided into concentric remodeling, eccentric hypertrophy and concentric hypertrophy. Differences of HRV index between correspond groups have been compared,and correlation of left ventricular injective fraction (LVEF), E/A, left ventricular mass indexs (LVMI) , relative wall thickness (RWT) with HRV index have been analysed. Results All HRV index was not singificantly different between left ventricular systolic disfunction and normal function group,and all HRV index of abnormal diastolic function group was singnificantly lower than that normal function group; SDNN,SDNNI,LF and HF of LVH group was singnifi-cantly lower than that normal group, except rMSSD and PNN50; All HRV index was higher in normal geometric patterns group than that abnormal group, however, all HRV index was not singnificauntly differences between all abnormal geometric patterns group. In a univariate regreesive analysis, RWT, LVMI and LVEF were closely related to most HRV index, and E/A was singnificantly related to all HRV indexs. In a multvatiate regreesive analysis, RWT was independently related to SDNN, LVMI was independently related to SNANN, LVEF was independently related to SDNN,and E/A was independently relate to LF. Conclusion Left ventricular disfunction, LVH and abnormal geometric patterns may impaired reguration of autonomic nerve function in hypertensive patients.