85例心率变异性与冠心病关系的临床研究

目的 既往研究表明冠心病患者的心率变异性减低明显,本研究应用24小时动态心电图检测探讨心率变异性与冠心病的关系。方法 选取35例经冠状动脉造影或双源冠脉CT检查诊断为冠心病的患者为观察组研究对象,另选50例经双源冠脉CT、冠状动脉造影等检查无明显冠脉血管病变者为对照组,对所有研究对象即85例患者均进行24小时动态心电图检查,对2组的心率变异性指标进行统计学分析比较,包括SDNN、RMSSD、pNN50、SDNN index和SDANN。结果 对照组的SDNN为（128.32±42.27）ms,RMSSD为（49.29±19.75）ms,pNN50为（14.86±16.67）%,SDNN index为（49.07±33.69）ms,SDANN为（102.61±35.02）ms,冠心病组的SDNN为（98.84±25.76）ms,RMSSD为（43.07±21.81）ms,pNN50为（5.42±5.62）%,SDNN index为（31.42±10.99）ms,SDANN为（89.37±24.06）ms。冠心病组的心率变异性指标SDNN、RMSSD、pNN50、SDNN index和SDANN较对照组明显降低,差异具有统计学意义（P〈0.01）。结论 冠心病患者的心率变异性明显降低,可能与其迷走神经功能受损有关。采用24小时动态心电图来进行心率变异分析,是一项进行心脏自主神经张力检测的无创技术,可用于评估冠心病患者自主神经系统损伤及其程度。

Relationship between heart rate variability and coronary heart disease

Objective To investigate the relationship between Heart Rate Variability（ HRV） and Coronary Heart Disease（ CHD） by using 24-hour Holter ECG. Methods 35 cases of CHD confirmed by double source coronary artery CT or coronary arteriography were selected as observation group,while 50 subjects without CHD were chosen as control. 24-hour Holter ECG monitoring were performed in all 85 individuals. The HRV indexes including SDNN,RMSSD,pNN50,SDNN index and SDANN were compared between the two groups. Results In the control group,the SDNN was（ 128. 32 ± 42. 27） ms,RMSSD was（ 49. 29 ± 19. 75） ms,pNN50 was（ 14. 86 ± 16. 67） %,SDNN index was（ 49. 07 ± 33. 69） ms, SDANN was（ 102. 61 ± 35. 02） ms. In the CHD group,SDNN was（ 98. 84 ± 25. 76） ms,RMSSD was（ 43. 07 ± 21. 81） ms,pNN50 was（ 5. 42 ± 5. 62） %,SDNN index was（ 31. 42 ± 10. 99） ms,SDANN was（ 89. 37 ± 24. 06） ms. SDNN, RMSSD,pNN50,SDNN index and SDANN in the CHD were distinctly reduced as compared to those in the control group. There was significant difference between the two groups（ P〈0. 01）. Conclusion The HRV significantly reduces in the CHD patients which is perhaps associated with the impaired vagus nerve. The HRV analysis using 24 hour dynamic echocardiogram is a noninvasive technology to detect the cardiac autonomic nerve tension and can be used to evaluate the autonomic nerve tension impairment extent in CHD patients.