冠心病合并不同程度抑郁患者心率变异性分析

目的探讨抑郁对冠心病患者心率变异性(HRV)的影响。方法将临床确诊为冠心病的120例患者应用Zung抑郁自评量表(SDS)评定抑郁状况。抑郁严重度指数<0.5为无抑郁,0.5≤抑郁严重度指数<0.6为轻度抑郁;抑郁严重度指数≥0.6为中重度抑郁,据此分为抑郁组(64例)和非抑郁组(56例),将抑郁组患者再分为轻度抑郁组(40例)和中重度抑郁组(24例)。应用24 h动态心电监测仪记录各组患者的HRV,分析抑郁对冠心病患者HRV时域指标和频域指标的影响。结果冠心病患者合并抑郁组时域指标:指定时间内所有正常窦性R-R间期总体标准差(SDNN)、指定时间内每5 min窦性R-R间期均值标准差(SDANN)、指定时间内每5min窦性R-R间期标准差的均值(SDNNDX)、指定时间内正常连续窦性R-R间期差值均方根(RMSSD)及每两个相邻R-R间期差值>50 ms的个数所占的百分比(PNN50)均显著低于非抑郁组(83.66±15.71)ms比(111.02±25.56)ms,(77.99±18.46)ms比(89.43±14.12)ms,(45.56±10.72)ms比(53.17±14.71)ms,(37.90±9.28)ms比(44.96±17.92)ms,18.42%±4.68%比23.21%±11.79%,P<0.01或P<0.05];抑郁组频域指标:极低频功率(VLF)及低频功率(LF)显著高于非抑郁组(160.23±44.27)Hz/ms~2比(141.78±54.19)Hz/ms~2,(353.28±43.41)Hz/ms~2比(292.81±64.63)Hz/ms~2,P<0.01],而高频功率(HF)显著低于非抑郁组(P<0.05)。抑郁严重度指数与SDNN、SDANN、SDNNDX、PNN50均显著负相关(r=-0.536、-0.250、-0.273、-0.185),抑郁严重度指数与LF和LF/HF均呈显著正相关(r=0.207、0.26)。结论合并抑郁的冠心病患者HRV降低,且抑郁程度对HRV具有显著影响。

Change of heart rate variability in patients with coronary heart disease and depression

Objective To evaluate the influence of depression on heart rate variability （HRV） of patients with coronary heart disease （CHD）. Methods A total of 120 CHD patients were evaluated with Zung Self-Rating Depression Scale （SDS） and were divided into non-depression group （n = 56, depression severity index 〈 0. 5） , minor depression group （n =40, depression severity index t〉0. 5 and 〈0. 6） and moderate to severe depression group （n =24, depression severity index ≥0. 6）. HRV was determined by 24h dynamic electrocardiogram （Holter） monitoring. Results SDNN, SDANN, SDNNDX, RMSSD, PNNS0 and HF were significantly lower and VLF and LF significantly higher in depression group than in non-depression group （ all P 〈 0. 05）. Depression severity index was negatively related with SDNN, SDANN, SDNNDX and PNNS0 （r = - 0. 536, - 0. 250, - 0. 273 and - 0. 185, respectively） and positively correlated with LF and LF/HF （r = 0. 207 and 0. 26, respectively）. Conclusions HRV is decreased in patients with CHD and depression.