| 心率变异性联合心功能相关指标与慢性心力衰竭病人病情及室性心律失常的关系 |
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| 引用本文： | 吴婷玉,王本芳,徐玮,姚慧强,徐淑楠,黄宇理.心率变异性联合心功能相关指标与慢性心力衰竭病人病情及室性心律失常的关系[J].蚌埠医学院学报,2022,47(12):1647-1653. |
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| 作者姓名： | 吴婷玉 王本芳 徐玮 姚慧强 徐淑楠 黄宇理 |
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| 作者单位： | 蚌埠医学院第一附属医院 心血管科, 安徽 蚌埠 233004 |
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| 基金项目： | 安徽省高校自然科学研究重点项目SK2021A0433安徽省高校自然科学研究重点项目SK2020A0351 |
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| 摘 要： | 目的探讨心率变异性（HRV）联合心功能相关指标与慢性心力衰竭（CHF）病人的病情及室性心律失常（VA）的关系。方法分析89例CHF病人的临床资料，分别按美国纽约心脏病协会（NYHA）心功能分级、左心室射血分数（LVEF）及VA对病人进行分组，比较不同分组HRV时域指标24小时NN间期的标准差（SDNN-24h）、全程每5分钟NN间期平均值的标准差（SDANN）、全程每5分钟NN间期标准差的平均值（SDNN index）、全程相邻NN间期差值的均方根（rMSSD）、相邻NN间期之差大于50 ms的个数占总窦性心搏个数的百分比（PNN50）]、脑钠肽（BNP）、超声心动图相关指标LVEF、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）]、室性期前收缩总数的关系。采用多因素二元logistic回归模型分析CHF病人发生VA的影响因素。并将SDNN-24h、LVEF、BNP指标两两进行直线相关分析。结果CHF的病因中以冠心病占比最高（56.2%）。NYHA心功能Ⅳ级组BNP、LVEDD、LVESD大于Ⅰ~Ⅱ级组和Ⅲ级组；Ⅳ级组LVEF、SDANN小于Ⅰ~Ⅱ级组和Ⅲ级组；Ⅲ级组SDNN-24h大于Ⅳ级组；Ⅲ级组rMSSD大于Ⅰ~Ⅱ级组，差异均有统计学意义（P < 0.05~P < 0.01）。射血分数保留心衰（HFpEF）组BNP、LVEDD、LVESD小于射血分数中间范围的心衰（HFmrEF）组和射血分数降低的心衰（HFrEF）组；HFpEF组LVEF、SDNN-24h、SDANN、SDNN index、rMSSD、PNN50大于HFmrEF组和HFrEF组，HFmrEF组LVEF大于HFrEF组，差异均有统计学意义（P < 0.05~P < 0.01）。VA阳性组男性占比、BNP、LVEDD、LVESD、SDNN index大于阴性组；阳性组LVEF低于阴性组，差异均有统计学意义（P < 0.05~P < 0.01）。SDNN index（OR:1.033，95%CI:1.012~1.053，P < 0.01）和LVEDD（OR:1.124，95%CI:1.069~1.182，P < 0.01）增加是VA的危险因素。LVEF与SDNN-24h呈显著正相关，BNP与SDNN-24h、LVEF呈显著负相关（P < 0.05）。结论HRV联合心功能相关指标可更全面评估CHF病人的病情及预测VA的发生。
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| 关 键 词： | 慢性心力衰竭 心率变异性 心功能 室性心律失常 |
| 收稿时间： | 2021-10-19 |
Relationship between heart rate variability combined with cardiac function-related indicators and the condition of patients with chronic heart failure and ventricular arrhythmias |
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| Affiliation: | Department of Cardiovascular, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China |
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| Abstract: | ObjectiveTo investigate the relationship between heart rate variability (HRV) combined with cardiac function-related indicators and the condition of patients with chronic heart failure (CHF) and ventricular arrhythmias (VA).MethodsThe clinical data of 89 CHF patients were analyzed, and the patients were grouped according to the New York Heart Association (NYHA) cardiac function classification, left ventricular ejection fraction (LVEF) and VA. The HRV time domain indicators (SDNN-24h, SDANN, SDNN index, rMSSD, PNN50), brain natriuretic peptide (BNP), echocardiography-related indicators (LVEF, LVEDD, LVESD), and total number of preventricular contractions were compared among the different groups. A multifactorial binary logistic regression model was used to analyze the factors influencing the development of VA in patients with CHF. The SDNN-24h, LVEF and BNP indicators were analyzed by two-by-two linear correlation.ResultsThe coronary heart disease accounted for the highest proportion of CHF causes (56.2%). The BNP, LVEDD and LVESD in NYHA cardiac function class Ⅳ group were greater than those in class Ⅰ-Ⅱ group and class Ⅲ group, the LVEF and SDANN in class Ⅳ group were less than those in class Ⅰ-Ⅱ group and class Ⅲ group, the SDNN-24h in class Ⅲ group was greater than that in class Ⅳ group, the rMSSD in class Ⅲ group was greater than that in class Ⅰ~Ⅱ group, and the difference was statistically significant (P < 0.05 to P < 0.01). The BNP, LVEDD and LVESD in HFpEF group were less than those in HFmrEF and HFrEF groups, the LVEF, SDNN-24h, SDANN, SDNN index, rMSSD and PNN50 in HFpEF group were larger than those in HFmrEF and HFrEF groups, and LVEF in HFmrEF group was larger than that in HFrEF group, with statistically significant differences (P < 0.05 to P < 0.01). The percentage of males, BNP, LVEDD, LVESD and SDNN index were greater in the positive VA group than those in the negative group, the LVEF was lower in the positive group than that in the negative group, and the difference was statistically significant (P < 0.05 to P < 0.01). Increased SDNN index (OR: 1.033, 95%CI: 1.012-1.053, P < 0.01) and LVEDD(OR: 1.124, 95%CI: 1.069-1.182, P < 0.01) were risk factors for VA. The LVEF was positively correlated with SDNN-24h, the BNP was negatively correlated with SDNN-24h and LVEF (P < 0.05).ConclusionsThe combination of HRV and cardiac function-related indicators can more comprehensively evaluate the condition of CHF patients and predict the occurrence of VA. |
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