高血压前期患者的心脏自主神经功能异常及其危险因素分析

目的 评估高血压前期(PHT)患者心脏自主神经功能及探讨其相关危险因素.方法 选择2015年1月至2016年5月在我院诊断的80例符合《中国高血压防治指南(2010)》PHT诊断标准的PHT患者作为PHT组,同期血压正常的健康人70例作为对照组,监测窦性心率变异性(HRV)参数,包括所有窦性R-R间期标准差(SDNN)、相邻窦性R-R间期差值均方根(RMSSD)、相邻窦性R-R间期差值超过50 ms心搏百分比(pNN50)和窦性心率震荡(HRT)参数包括震荡初始(TO)、震荡斜率(TS),对比两组的临床特征,用Spearman相关分析和多元线性回归分析寻找影响HRV和HRT的危险因素.结果 与对照组比较,PHT组患者的年龄、体质指数、腰围、空腹血糖、收缩压、舒张压、血甘油三酯、TO较高,高密度脂蛋白胆固醇、SDNN、RMSSD、pNN50、TS较低,差异均有统计学意义(P<0.05);PHT患者中,SDNN的影响因素为年龄(β=-0.261,P<0.01)、收缩压(β=-0.252,P<0.01)、空腹血糖(β=-0.286,P<0.01)和血甘油三酯(β=-0.184,P<0.05);RMSSD的影响因素为收缩压(β=-0.232,P<0.05)、空腹血糖(β=-0.192,P<0.05);pNN50的影响因素为收缩压(β=-0.224,P<0.01)、空腹血糖(β=-0.224,P<0.05);TO的影响因素为年龄(β=0.220,P<0.05)、收缩压(β=0.203,P<0.05)、空腹血糖(β=-0.197,P<0.05);TS的影响因素为年龄(β=-0.395,P<0.01)、收缩压(β=-0.197,P=0.01)、空腹血糖(β=-0.195,P<0.05).结论 PHT患者心脏迷走神经活性降低,交感神经活性增强,空腹血糖、收缩压、年龄、甘油三酯水平可能是心脏自主神经病变的危险因素.

Cardiac autonomic dysfunction in patients with prehypertension and its risk factors

Objective To evaluate the cardiac autonomic dysfunction (CAD) in patients with prehypertension (PHT) and its related risk factors. Methods Eighty PHT patients in Shenzhen Futian Hospital for Chronic Disease Con-trol and Prevention from January 2015 to May 2016, which were diagnosed according to the diagnostic criteria for PHT mentioned in the"Chinese Hypertension Guide 2010", were selected as the PHT group. At the same time, 70 healthy controls were enrolled (control group). The standard deviation of all normal-to-normal intervals (SDNN), the square root of the mean squared differences of successive normal-to-normal intervals (RMSSD), the division of the number of interval differences of successive normal-to-normal intervals of more than 50 ms by the total number of normal-to-nor-mal intervals (pNN50), turbulence onset (TO) and turbulence slope (TS) were detected. The clinical characteristics were compared and the risk factors were performed by using Spearman correlation analysis and multiple linear regression anal-ysis. Results In PHT group, age, body mass index (BMI), waist circumference, fasting plasma glucose (FPG), systolic blood pressure (SBP), diatolic blood pressure (DBP), plasma triglycerides (TG) and TO were significantly higher, while high density lipoprotein cholesterol (HDL-C), SDNN, RMSSD, pNN50, and TS decreased significantly, compared to those in control group (all P<0.05). The risk factors of SDNN included age (β=-0.261, P<0.01), SBP (β=-0.252, P<0.01), FPG (β=-0.286, P<0.01) and TG (β=-0.184, PP<0.05). The risk factors of RMSSD were SBP (β=-0.232, P<0.05), FPG (β=-0.192, P<0.05). The risk factors of pNN50 were SBP (β=-0.224, P<0.01), FPG (β=-0.224, P<0.05). The risk factors of TO were age (β=0.220, P<0.05), SBP (β=0.203, P<0.05) and FPG (β=0.197, P<0.05). The risk factors of TS were age (β=-0.395, P<0.01), SBP (β=-0.197, P=0.01) and FPG (β=-0.195, P<0.05). Conclusion Cardiac auto-nomic function in patients with PHT declines obviously. FPG, SBP, age and TG may be closely associated with cardiac autonomic dysfunction.