扩张型心肌病患者心率变异性及其相关因素的研究

目的 :借助心率变异性 (HRV)分析的方法了解扩张型心肌病 (DCM )患者自主神经系统受损状况及其相关因素 ,初步探讨DCM患者心血管事件高发的原因。 方法 :DCM患者 2 5例 ,临床评价心功能NYHAⅡ～Ⅳ级 ;Holter监测 2 4h ,2 3:0 0～ 5 :0 0为夜间 ,室性心律失常按Lown法分级 ,并行 2 4h长程及昼夜的HRV频域、时域分析 ;超声心动图测量左房与左室舒张末期直径、射血分数、E/A峰比值等。比较DCM患者HRV指标与国人正常参考值之间的差异 ;比较DCM患者昼夜HRV指标差异 ;计算DCM患者 2 4hHRV指标与临床参数的相关性。结果 :DCM患者的 2 4hHRV指标除低频外 ,其余均显著低于正常参考值 ;DCM患者的昼、夜HRV指标无差异 ;DCM患者的 2 4hHRV指标中仅SDNN与左心房大小存在中度负相关性 (r =- 0 .4 9) ,其余HRV指标与临床参数之间无统计学相关性。结论 :DCM患者在总体心率变异显著降低的基础上 ,以迷走神经张力低下和HRV昼夜节律性丧失为突出表现 ;且HRV的变化与心腔大小、心功能等多项临床参数之间无相关性 ,它们各自均为DCM患者发生心血管事件的独立危险因子。

Heart rate variability and its clinical correlative factors in patients with dilated cardiomyopathy

Objective:To examine the heart rate variability (HRV) and its relationship to some clinical variables in patients with dilated cardiomyopathy(DCM).Method: Twenty-four-hour HRV between DCM patients and normal field was compared, including day and night HRV in time and frequency domain. The correlation coefficient between HRV parameters and clinical variables was also investigated.Result: HRV parameters, except LF, were significantly lower than normal field, and there was no difference between day and night HRV in DCM patients. HRV parameters in DCM had no correlation to the clinical variables, except left atrial size.Conclusion: Decreased HRV, shown as low tonic vagal activity and loss of circadian rhythms, has independent prognostic value in DCM patients.