慢性充血性心力衰竭患者心率变异性及其昼夜节律变化

目的分析慢性充血性心力衰竭(CHF)患者心率变异性(HRV)及其昼夜节律的变化,了解CHF患者自主神经功能损害与心功能的关系。方法用24小时动态心电图分析38例CHF患者,20例心功能代偿的心血管病患者心功能代偿组,16例健康体检者对照组的HRV时域指标。比较三组间HRV指标的差异;计算CHF患者HRV昼夜指标差异,分析CHF患者24小时HRV指标变化与心功能NYHA分级的关系。结果心功能代偿组24小时HRV时域指标SDNN、SDANN和SDNNindex较对照组显著下降P<0.01、0.05和0.05rMSSD和pNN50与对照组无显著差别P>0.05;CHF组的HRV各指标均显著低于对照组均P<0.01且昼夜指标变化无差异;将CHF组分为心功能Ⅱ级组n=20和心功能≥Ⅲ级n=18两个亚组结果发现心功能≥Ⅲ级的HRV各指标明显低于心功能Ⅱ级组P<0.01。结论心血管病患者可能在心功能代偿期时自主神经的平衡就已受到损害当出现CHF时交感活性增强迷走神经张力进一步下降,自主神经调节昼夜节律性丧失,且HRV指标的下降与心功能损害程度相关因此HRV时域指标可作为评价CHF预后指标之一。     

44例慢性肾衰竭患者心率变异性分析

目的 研究慢性肾衰竭(CRF)患者的心率变异性(HRV)特征.方法选择CRF患者44例作为观察组,健康体检者38例作为对照组,用24小时动态心电图方法分析2组HRV时阈指标的变化,并比较慢性肾衰竭组HRV昼夜时阈指标;再将CRF组分作2个亚组,肾衰竭期组(n=24)与尿毒症期组(n=20),比较2亚组的HRV指标.结果与对照组比较,慢性肾衰竭组HRV各值均显著降低(P<0.01,P<0.05),且慢性肾衰竭组HRV昼夜指标无差异;亚组间比较,尿毒症期组HRV各值较肾衰竭期组均显著下降(P<0.01,P<0.05).结论慢性肾衰竭患者均有自主神经功能损害,其自主神经调节的昼夜节律丧失,且HRV指标的下降程度与肾功能损害程度相关.     

冠心病、糖尿病气阴两虚证患者心率变异性研究

目的研究气阴两虚证患者心率变异性（HRV）的变化情况。并分析不同疾病（冠心病、糖尿病）相同证候是否有相似的自主神经功能状态。方法气阴两虚证患者124倒,其中冠心病组61例,糖尿痛组63例,另选同年龄段健康者66例为对照组。分析3组观察者HRV时域指标（SDNN。SDANN,rMSSD,PNN50,HRV index,DI）、频域指标（总功率、极低频、低频、高频）。结果气阴两虚证患者HRV时域指标（SDNN,SDANN,rMSSD,HRVindex）、频域指标（总功率、极低频、低频、高频）均低于对照组（P〈0．05）。冠心病组与糖尿病组HRV时域、频域指标比较无统计学意义。结论气阴两虚证患者自主神经功能严重受损,不同疾病（冠心病、糖尿病）相同证候HRV变化具有一致性。     

老年高血压合并糖尿病患者心率变异性及其昼夜变化临床分析

目的研究老年高血压合并糖尿病患者的心率变异性(HRV)及其昼夜变化规律,探讨老年糖尿病患者心脏自主神经变化的临床意义。方法选择87例原发性高血压患者(EH组)及68例高血压合并糖尿病患者(EH+DM组),监测24 h动态心电图,进行HRV时域指标SDNN、SDANN、SDNN Index、RMSSD、PNN50的分析。比较2组间HRV指标的差异以及HRV昼夜指标差异。结果 EH+DM组较EH组24 h、日间、夜间HRV各项指标均明显降低,且有统计学差异;EH组SDNN以及RMSSD呈昼低夜高,但无明显统计学差异,SDNN Index和PNN50仍呈昼低夜高现象(P0.01);EH+DM组SDNN以及RMSSD呈昼高夜低现象(P0.05),SDNN Index和PNN50昼夜间无统计学差异。结论老年高血压合并糖尿病患者HRV显著降低,高血压患者昼夜节律已有明显受损,高血压合并糖尿病患者昼夜节律进一步受损,心脏自主神经功能失调。     

高血压伴恶性室性早搏患者心律振荡分析的意义

心律振荡（HRT）分析是一项比心率变异（HRV）更强的评估自主神经功能状态，预测死亡危险性的指标。我们对86例原发性高血压伴室性早搏（室早）患者与34例正常人对照，进行24h Hoher监测，旨在探讨高血压伴恶性室早和偶发室早病人与正常人HRT、HRV及Q—T变异分析的临床意义。     

老年心力衰竭患者自主神经功能与心功能的相关性研究

目的 探讨老年心力衰竭(CHF)患者自主神经功能活动与心功能受损严重程度的相关性。方法 分析61例老年CHF患者和30例对照者的心率变异性时域指标及心功能指标。结果 CHF组与对照组比较，HRV各测值均非常显著降低(均P＜0．001)；HRV各测值均随心功能的下降而呈递减性下降，在心功能各级别间具有显著差异(P＜0．05或P＜0．001)，SDNN和TI下降与心功能NYHA分级呈负相关(P＜0．01)。结论 老年CHF患者存在着严重的自主神经功能受损和失衡，且与心功能损害程度密切相关。     

心血管神经机能症的短时心率变异研究

应用短时心率变异（HRV）分析研究108例心血管神经机能症患者站卧两个体位的自主神经功能。结果显示：与正常人相比，心血管神经机能症患者站卧位的SDNN、HRVindex、RMSSD、PNN50、TP、LF、HF、HFnorm均低于正常人（P＜0．01）；而LF／HF、LFnorm高于正常人（P＜0．05）；正常人由卧位转为站位时，自主神经发生相应调节，表现交感神经活性增加，迷走神经活性降低。心血管神经机能症患者卧位变站位时HRV变化趋势与正常人基本相同，只是变化程度减小（LF／HF除外）。正常人SDNN、HRVindex、RMSSD、PNNS50、TP、LF、HFnorm与年龄呈负相关（P＜0．05）。心血管神经机能症患者除站位LF外，HRV各指标与年龄的相关比较均P＞0．05。     

心率昼夜节律与全因死亡患者自主神经功能的关系

高血压患者心率昼夜节律是反映病情进展及交感神经和迷走神经激活水平的重要指标.心率变异(HRV)可定量测定高血压发生、发展及死亡等各个过程中患者自主神经功能受损程度.通过对139例高血压患者进行为期0.5 ～5年追踪随访,以探讨非杓型心率和血压与全因死亡患者自主神经功能受损程度,为高血压患者的预后提供预警依据.     

老年原发性高血压患者心率变异特点及其与肾功能损害的关系

目的 探讨老年高血压伴左心室肥厚(LVH)患者心率变异性(HRV)特点,评价高血压患者的HRV与肾功能损害的关系.方法 选取老年高血压患者159例,其中单纯高血压组41例,高血压伴LVH的患者65例;伴肾功能损害者53例,选择健康者50例作为对照组,进行HRV时域分析.对入选者做以下检查:心电图、超声心动图、24 h动态心电图、空腹血糖(FPG)、总胆固醇(TC) 和甘油三酯(TG)、血肌酐.结果 老年高血压患者HRV各项指标低于对照组(P<0.01);高血压伴左室肥厚HRV与对照组比较,差异有显著性(P<0.01).高血压伴肾功损害HRV与对照相比较,差异有显著性(P<0.05).结论 老年高血压尤其是伴左心室肥厚患者及肾功能损害患者的HRV减低,即自主神经对心脏的调节能力减弱,因此可通过自主神经功能受损程度来估计靶器官受损的程度和判断预后.     

特发性肺间质纤维化患者心率变异性时域分析

目的　通过心率变异性 (heart rate variability,HRV)时域分析评价特发性肺间质纤维化 (idiopathicpulmonary fibrosis,IPF)患者心脏自主神经功能损害。方法　分别对 1 6例有 型呼吸衰竭、1 3例无呼吸衰竭的IPF患者和 2 4例正常人进行 2 4小时动态心电图监测及 HRV时域分析。结果　 IPF患者 HRV各项指标 SDNN、SDANNI、SDNNI、r MSSD及 PNN5 0均明显低于正常对照组 (P<0 .0 5或 0 .0 1 ) ,尤其以存在 型呼吸衰竭的患者更明显。上述时域指标与 DLCO、Pa O2 呈正相关 (r值 0 .73～ 0 .89,P<0 .0 5 )。结论　 IPF患者心脏自主神经功能受损 ,HRV时域分析可作为一种无创性评价 IPF患者心脏自主神经功能的方法     

2型糖尿病下肢神经病变心率变异性频域参数的昼夜节律

采用24 h动态心电图检测58例2型糖尿病伴下肢神经病变组、59例2型糖尿病不伴下肢神经病变组(非下肢神经病变组)和50例对照组的心率变异性,比较其频域参数的水平及昼夜间的变化.结果 显示非下肢神经病变组、下肢神经病变组较对照组频域指标减小,平均心率增加;昼夜间比较在对照组差异有统计学意义,在非下肢神经病变组昼夜节律发生改变,在下肢神经病变组昼夜节律消失.提示糖尿病不伴和伴下肢神经病变均存在自主神经功能受损,后者受损更明显.

Abstract：

Heart rate variability(HRV)analysis and its circadian rhythm(CR)were determined in 58patients with type 2 diabetes mellitus with lower extremity neuropathy(diabetic neuropathy group), 59 patients with type 2 diabetes mellitus without lower extremity neuropathy(diabetes group), and 50 healthy controls according to 24-hour Holter recording. Frequency domain parameters of HRV were significantly decreased in both diabetes groups. Frequency domain parameter of HRV in healthy controls,and daytime/nighttime difference were statistically significant. CR of HRV was changed in diabetes group and disappeared in diabetic neuropathy group. Impaired and seriously impaired autonomic nervous function developed in type 2 diabetes mellitus without and with lower extremity neuropathy respectively.     

糖尿病与冠心病患者心率变异性分析

目的 探讨糖尿病与冠心病患者心率变异（ＨＲＶ）改变及其异同,并观测疾病状态下ＨＲＶ改变的昼夜节律性。方法 观察２５例糖尿病患者、２例冠心病患者及４８名健康人２４ｈ、白天段及夜间段心率变异长程时域。结果 糖尿病组与冠心病组ＨＲＶ各指标ＳＤＮＮ、ＲＭＳＳＤ、ＰＮＮ５０、ＳＤＡＮＮ均显著低于健康对照组（Ｐ〈０．０１）。糖尿病组与冠心病组及２组内白天与夜间ＨＲＶ各指标比较均无显著性差异。结论 糖尿病、冠心     

绞股蓝总皂甙治疗早期慢性肾衰竭患者的临床观察

目的探讨绞股蓝总皂甙对早期慢性肾衰竭患者肾功能、血脂、营养状况和血红蛋白的影响。方法将68例慢性肾衰竭患者随机分为对照组(32例)和治疗组(36例),对照组行常规治疗,治疗组应用绞股蓝总皂甙片治疗,疗程均为6个月。结果治疗组患者血脂、肾功能、营养状况明显改善,血红蛋白明显升高,而对照组肾功能、血脂和营养状况无明显变化,血红蛋白反而下降。结论绞股蓝总皂甙具有降低早期慢性肾功能衰竭患者血脂和改善贫血、肾功能和营养状况的作用。     

泼尼松联合双嘧达莫治疗小儿肾病综合征的临床疗效及对患儿肾功能与凝血功能的影响

目的探讨泼尼松联合双嘧达莫治疗小儿肾病综合征(NS)的临床效果以及对患儿肾功能、凝血功能的影响。方法选取2017年1月至2020年3月本院收治的NS患儿62例,采用随机数字法分成实验组(32例)与对照组(30例)。在常规治疗的基础上,对照组患儿给予泼尼松治疗,实验组患儿给予泼尼松及双嘧达莫治疗,治疗1个月后比较两组患儿的临床治疗效果;比较两组患儿治疗前后的肾功能及凝血功能。结果实验组患儿的临床疗效明显优于对照组,差异有统计学意义(P<0.05)。治疗前,两组患儿的血肌酐(Scr)、尿素氮(BUN)及肌酐清除率(Ccr)水平比较,差异无统计学意义(P>0.05);治疗1个月后,两组患儿的Scr、BUN水平均显著降低并且实验组患儿的水平显著低于对照组,两组患儿Ccr水平均显著升高并且实验组患儿的水平显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患儿的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)比较,差异无统计学意义(P>0.05);治疗1个月后,两组患儿的APTT、PT均显著增加,实验组患儿的APTT、PT显著大于对照组,差异有统计学意义(P<0.05)。结论泼尼松联合双嘧达莫治疗小儿NS的临床效果显著,能明显改善患儿的肾功能及凝血功能,值得推广应用。     

羟苯磺酸钙治疗慢性肾功能衰竭患者的临床疗效观察

目的：观察羟苯磺酸钙治疗慢性肾功能衰竭的临床疗效。方法：90例慢性。肾功能衰竭患者随机分为治疗组和对照组。两组患者在入院后均根据病情给予常规治疗,治疗组在常规治疗基础上给予羟苯磺酸钙,剂量为0．5g／次,1日3次,疗程8周。观察两组患者治疗前后尿素氮、血肌酐、内生肌酐清除率、尿蛋白和血红蛋白的变化。结果：与对照组比较,治疗组总有效率明显升高,血尿素氮、血肌酐和尿蛋白明显下降,内生肌酐清除率和血红蛋白明显升高,两组比较有统计学意义（P〈0．05）。结论：羟苯磺酸钙可有效治疗慢性肾功能衰竭患者．佰得推广府用。     

Melatonin levels decrease in type 2 diabetic patients with cardiac autonomic neuropathy

The present study has been designed to determine melatonin levels in type 2 diabetic patients and test the relationship between the autonomic nervous system and melatonin dynamics. Thirty-six type 2 diabetic patients and 13 age-matched healthy subjects were recruited for the study. Circadian rhythm of melatonin secretion was assessed by measuring serum melatonin concentrations between 02:00-04:00 and 16:00-18:00 hr. Melatonin dynamics were re-evaluated with respect to autonomic nervous system in diabetic patients with autonomic neuropathy who were diagnosed by the cardiovascular reflex tests, heart rate variability (HRV), and 24-hr blood pressure monitoring. Nocturnal melatonin levels and the nocturnal melatonin surge were low in the diabetic group (P = 0.027 and 0.008 respectively). Patients with autonomic neuropathy revealed decreased melatonin levels both at night and during day when compared with healthy controls (P < 0.001 and 0.004 respectively) while the melatonin dynamics were similar to controls in patients without autonomic neuropathy. Nocturnal melatonin level was positively correlated with nocturnal high and low frequency components of HRV (P = 0.005 and 0.011 respectively) and systolic and diastolic blood pressures at night (P = 0.002 and 0.004 respectively) in patients with autonomic neuropathy. We found a negative correlation between nocturnal melatonin levels and the degree of systolic blood pressure decrease at night (r = -0.478, P = 0.045). As a conclusion this study has shown that circadian rhythm of melatonin secretion is blunted in type 2 diabetic patients and there is a complex relationship between various components of autonomic nervous system and melatonin secretion at night. Among the patients with autonomic neuropathy those with more preserved HRV and the systolic nondippers (<10% reduction in blood pressure during the night relative to daytime values) have more pronounced melatonin surge at night.     

The relationship between autonomic neuropathy and urinary sodium and albumin excretion in insulin-treated diabetics

There is evidence to suggest that renal function may alter in the presence of autonomic neuropathy. Albumin excretion rate (AER) and sodium excretion rate (NaER) in timed daytime (erect) and night-time (supine) urine collections were assessed in 20 insulin-treated diabetics with and in 20 without established autonomic neuropathy, matched for age, sex, duration of diabetes, diabetic control, and systolic blood pressure. All patients were free of proteinuria on albustix testing and had normal serum levels of urea and creatinine. AER based on daytime and pooled 24-hour collections was higher, but not significantly so, in the group with autonomic neuropathy. The nocturnal AER on the other hand was significantly elevated in the group with autonomic neuropathy (p less than 0.02) as was the nocturnal urine volume (p less than 0.01) and sodium excretion rate (p less than 0.05). The corrected nocturnal albumin/creatinine ratio was likewise greater in this group (p less than 0.02). These findings suggest that autonomic neuropathy can independently affect renal function and that nocturnal renal haemodynamics and glomerulotubular balance may be deranged in insulin-treated diabetics with autonomic neuropathy.     

血清巯基蛋白酶抑制肽C诊断肝硬化肾受损的价值

探讨血清巯基蛋白酶抑制肽C(CysC)对失代偿期肝硬化患者肾受损的诊断价值。根据24h肌酐清除率(Ccr)将92例肝硬化患者分为肾功正常组、代偿组和肝肾综合征(HRS)组;上述所有患者均检测血肌酐(Scr)、CysC和Ccr;CysC采用颗粒增强免疫比浊法(PETIA)。结果显示血清CysC的浓度在代偿组和HRS组明显高于肾功正常组(P<0．001);而Scr的浓度在代偿组和肾功正常组之间无明显差异(P>0．05),HRS组Scr的浓度明显高于代偿组和肾功正常组(P<0．001);Ccr与CysC和Scr呈负相关(r分别为-0．780和-0．699,P<0．01)。说明血清CysC的测定对肝硬化患者肾功能损害具有诊断价值,尤其对轻中度肾受损的早期诊断明显优于Scr。     

Alteration of renal function in hyperthyroidism: increased tubular secretion of creatinine and decreased distal tubule delivery of chloride.

In 77 untreated patients (16 males and 61 females, aged 12 to 65 years) with hyperthyroid Graves' disease, and in 107 control subjects (36 males and 71 females, aged 13 to 78 years), blood urea nitrogen (BUN), serum creatinine (Scr) levels, and BUN to Scr ratios (BUN/Scr) were determined. In 53 patients, the determinations were performed before treatment and after restoration of euthyroidism by treatment with an antithyroid drug. In addition, in seven untreated patients and seven normal subjects, renal clearances of creatinine (Ccr), urea nitrogen (Cun), inulin (Cin), and p-aminohippurate (CPAH) were also determined. The distal tubule delivery of chloride (DTD) and the distal fractional chloride reabsorption (DFCR) were also measured in these subjects: DTD = (CH2O + Ccl)/Cin x 100, and DFCR = CH20/(H20 + Ccl) x 100, where CH20 and Ccl stand for clearances of H2O and chloride, respectively. BUN was significantly elevated, while Scr was significantly depressed, in untreated patients with hyperthyroid Graves' disease. Accordingly, the BUN/Scr was markedly elevated. Restoration of euthyroidism accompanied the normalization of all these abnormalities. Ccr and Cun were significantly elevated, but Cin (glomerular filtration rate [GFR]) was slightly, but insignificantly, elevated in the patients. As a result, the ratios Ccr/Cin and Cun/Cin were significantly greater in the patients than in controls (Ccr/Cin, 1.42 v 1.00; Cun/Cin, 0.92 v 0.68). The amounts of urinary creatinine and urea nitrogen (UN) excretion were decreased and increased, respectively, and DTD was significantly depressed, but DFCR was unchanged in the patients. We conclude that BUN is elevated, Scr is depressed, and the BUN/Scr is increased in hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)     

心率变异时域分析对糖尿病患者自主神经功能的评价

采用２４小时动态心电图对８２例糖尿病患者进行心率变异（ＨＲＶ）和心率（ＨＲ）检测。８２例分为五组：Ａ组（无血管合并症）３０例、Ｂ组（合并大血管病变）１１例、Ｃ组（合并小血管病变）１２例、Ｄ组（同时合并大、小血管病变）１９例和Ｅ组（心肾功能不全）１０例，并设正常对照组。结果：糖尿病各组ＨＲＶ显著降低，Ａ组仅２４ｈ内全部正常ＲＲ间期标准差（ＳＤＮＮ，１０４．２０±２９．１９ｍｓ）和２４ｈ内５ｍｉｎ节段平均正常ＲＲ间期的标准差（ＳＤＡＮＮｉｎｄｅｘ，９３．７３±２７．５８ｍｓ）降低（对照组分别为１２７．５２±３８．５７ｍｓ和１１６．１９±３５．７０ｍｓ），Ｐ均＜０．０１；ＨＲ异常主要表现为夜间平均ＨＲ增快，白昼平均ＨＲ仅Ｅ组（８６．７６±１１．３６ｂｐｍ）高于对照组（７６．３８±９．４０ｂｐｍ），Ｐ＜０．０１。表明糖尿病患者存在自主神经受累，白昼心率增快可能是病情严重的征兆。