慢性充血性心力衰竭者C-反应蛋白、心率变异性的检测意义

目的分析慢性充血性心力衰竭（CHF）者C反应蛋白（CRP）、心率变异性（HRV）变化的意义，了解CHF者自主神经功能损害、心功能和CRP的关系。方法用24h动态心电图（DCG）分析40例CHF者（A组），22例心功能代偿的心血管病者（B组），20例健康体检者（C组）的HRV时域指标和CRP。比较三组间HRV指标和CRP的差异，分析A组24hHRV指标变化、CRP与心功能NYHA分级的相互关系。结果B组24hHRV时域指标SDNN、SDANN和较C组显著下降（P〈0．01、0．05），rMSSD和pNN50与c组比较差异无显著性（P〉0．05）；A组的HRV各指标均显著低于C组（P〈0．01），将A组分为心功能Ⅱ级组（n=21）和心功能≥Ⅲ级（n：19）两亚组，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）。同时，A组CRP明显高于C组，且与心衰程度成正相关。结论心血管病患者在心功能代偿期时自主神经的平衡可能受到损害。当出现CHF时交感活性增强，迷走神经张力进一步下降，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，而CRP可能是HRV指标的下降原因之一。     

冠心病慢性充血性心功能衰竭患者心率变异性及其昼夜节律变化

目的探讨冠心病慢性充血性心功能衰竭患者心率变异性及其昼夜节律的变化,以及自主神经功能损害与心功能的关系.方法用24 h动态心电图分析52例冠心病慢性充血性心功能衰竭患者(心功能衰竭组),33例冠心病心功能代偿期患者(心功能代偿组),23例健康体检者(对照组)的心率变异性时域指标和频域指标.比较三组间心率变异性时域指标的变化和慢性充血性心功能衰竭患者心率变异性昼夜频域指标变化;分析此类患者心率变异性时域指标变化与美国纽约心脏协会心功能分级的关系.结果冠心病心功能代偿组24 h心率变异性时域指标窦性心律R-R间期标准差、5 min窦性R-R间期平均值标准差和5 min窦性R-R标准差平均值较对照组显著下降(P<0.05),相邻R-R间期之差的均方根值、相邻R-R间期差值>50 ms的个数除以整R-R间期的个数的百分比和三角指数与对照组无显著差别(P>0.05);冠心病慢性充血性心功能衰竭组的各时域指标均显著低于对照组(均P<0.01),也低于心功能代偿组(均P<0.05),且昼夜频域指标变化无差异;将冠心病慢性充血性心功能衰竭组分为心功能Ⅱ级组(n=32)和心功能≥Ⅲ级(n=20)两个亚组,结果发现心功能≥Ⅲ级组心率变异性各时域指标明显低于心功能Ⅱ级组(P<0.05).结论冠心病患者可能在心功能代偿期自主神经平衡就已受到损害,当出现慢性充血性心功能衰竭时交感活性增强,迷走张力进一步下降,自主神经调节昼夜节律功能丧失,心率变异性指标的下降与心功能损害程度相关,因此心率变异性指标可作为评价慢性充血性心功能衰竭预后指标之一.     

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.     

不同程度慢性心力衰竭患者心律失常及其心率变异性的临床研究

目的探讨不同程度慢性心力衰竭(CHF)患者心律失常及其心率变异性(HRV)的变化和临床意义。方法采用24h动态心电图监测67例不同程度慢性心力衰竭患者(CHF组)和30例健康者(对照组),对心律失常及HRV的时域和频域指标进行对比分析。结果 CHF组各级心功能均以室性期前收缩发生最高,时域和频域指标均低于对照组(P<0.05),随着心功能下降,室性期前收缩发生率越高,HRV值越低,自主神经功能受损越明显,与心功能损害程度一致。结论不同程度CHF患者以室性期前收缩为主,HRV各项指标能反映患者自主神经功能状态,联合检测有助于判断CHF患者病情严重程度、预后和早期干预治疗。     

老年心力衰竭患者自主神经功能与心率变异性关系的研究

目的探讨老年充血性心力衰竭(CHF)患者自主神经功能活动与心功能受损的严重程度及与临床的相关性。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临床相关指标。结果(1)CHF组与对照组比较,HRV各测值均显著降低(P<0.01)。(2)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<0.05~0.01)。(3)除RV及E/A比值无显著差异(P>0.05)外,LVd、LVs、LVPWI、VS、LVEF均随心功能下降而呈显著改变(P<0.05~0.01)。(4)SDNN和TI下降与心功能NYHA分级、LVd和LVs、LVPW及IVS呈负相关(P<0.05~0.01),而与LVEF、E/A比值呈正相关(P<0.05~0.01)。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、左心室肥大以及左心室收缩与舒张功能减退的程度密切相关,HRV检测有助于老年CHF的早期诊断、心力衰竭的严重程度与预后的评估以及指导治疗。     

雄激素水平与老年慢性心力衰竭患者心功能及心率变异性的相关性

目的通过研究老年男性慢性心力衰竭(CHF)患者雄激素水平与心功能及心率变异性(HRV)的相关性。方法纳入老年男性100例,年龄60~96〔平均(79.16±6.98)〕岁,包括81例CHF患者(其中心功能Ⅰ级组19例,心功能Ⅱ级组23例、心功能Ⅲ级组20例、心功能Ⅳ级组19例)及19例对照者,以上各组均进行睾酮(T)水平测定,同时行心脏超声及24 h动态心电图检查测量左室射血分数(LVEF)及HRV时域指标,观察各组T水平及HRV变化。结果与对照组相比,各CHF组T水平均下降(P0.05);随着心功能恶化,血清T水平依次降低,各组差异显著(P0.05),且各CHF组血清T水平与LVEF显著正相关(r=0.833,P=0.000)。与对照组对比,各CHF组HRV各时域指标水平均下降(P0.05);随着心功能恶化,HRV时域指标越降低(P0.05),且CHF组HRV各时域指标均与其LVEF呈正相关。CHF组T与HRV各时域指标呈正相关(P0.05)。结论随着CHF的加重,T水平、HRV各时域指标均降低,且CHF患者T水平与HRV各时域指标呈正相关,T有可能通过影响HRV从而参与CHF进程。     

2型糖尿病患者动态血压及心率变异与肾病的相互关系

目的:探讨血压增高、血压昼夜节律异常和自主神经病变对糖尿病肾病的影响.方法:同步监测35例糖尿病肾病患者、35例糖尿病正常白蛋白尿患者和35例正常对照组的动态血压和动态心电图.结果:糖尿病肾病组24小时血压较正常白蛋白尿组和对照组明显增高,昼夜平均动脉压差值百分率下降(p<0.001);糖尿病正常白蛋白尿组虽然24小时平均血压与对照组无明显差异,但却已存在夜间血压升高,昼夜平均动脉压差值百分率下降(p<0.05～0.001);糖尿病肾病组HRV指标较糖尿病正常白蛋白尿组和对照组显著减小(P<0.01～0.001);糖尿病正常白蛋白尿组HRV各项指标也较对照组减小(P<0.01).结论:糖尿病肾病的发生、发展与血压升高、血压昼夜节律异常和糖尿病自主神经病变有关.     

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。     

心率变异分析对儿童β-肾上腺素能受体功能亢进症的诊断价值

目的监测β-肾上腺素能受体功能亢进症(β-亢进症)和甲状腺功能亢进症(甲亢)患儿心脏自主神经活性及其24h心率变异的昼夜节律,探讨自主神经活性改变在β-亢进症中的作用,并提出有关的诊断价值.方法 24小时动态心电图记录,分别检测β-亢进症和甲亢的心率变异分析(HRV),包括时域和频域指标,并分析其昼夜规律.结果 (1)24h总HRV频域各频段比较,提示高频标准单位(HFUN)和低频与高频比值(LF/HF)甲亢组和对照组差异有显著性(P<0.01),而甲亢组和β-亢进组差异无显著性.(2)清醒期HRV频域各频段比较,提示低频标准单位(LFUN),HFUN,LF/HF甲亢组和β-亢进组对比差异无显著性,二者与对照比较有显著差异(P<0.01).(3)睡眠期HRV频域各频段比较提示高频带(HF),LFU.,HFUN和LF/HF等β-亢进组和对照组差异无显著性,与甲亢组差异有显著性(P<0.01).(4)24h HRV时域变化提示β-亢进组和对照组24 h HRV时域变化均有明显昼夜节律,以相邻正常RR间期差值的均方根(rMSSD)和相邻RR间期差值>50ms的个数所占的百分比(pNN50)指标最敏感.而甲亢组24h HRV时域各指标明显低于对照组和β-亢进组(P<0.01),昼夜波动幅度明显减少,昼夜节律消失.结论β-亢进症由于对儿茶酚胺物质反应不同,表现为副交感神经减弱,而交感神经活性相对占优势,但仍表现明显昼夜规律,程度低于对照组,对其进行HRV分析具有重要的诊断价值.     

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。     

Heart rate variability in severe right or left heart failure: the role of pulmonary hypertension and resistances

BACKGROUND: The decrease in heart rate variability (HRV) might be related to the hemodynamic status in heart failure. However, HRV in patients with severe isolated right heart failure has not been extensively studied. AIMS: This study compared HRV in patients with congestive heart failure (CHF) and in patients with isolated right heart failure. METHODS: Time and frequency domain analysis of HRV on 24-h ECG recording was assessed in 15 healthy subjects and in two groups of patients with severe heart failure awaiting heart or heart/lung transplantation. These were 15 patients with CHF due to idiopathic dilated cardiomyopathy (IDC) and 10 patients with isolated right heart failure due to primary pulmonary hypertension (PPH). RESULTS: Measurement of HRV were significantly decreased in both groups of patients compared with the control group. Patients with IDC had higher pulmonary capillary wedge pressure than patients with PPH (P=0.04) but lower pulmonary artery pressure and lower pulmonary vascular resistance (PVR) (P<0.0001). However, all the measurements of HRV were significantly lower in patients with IDC than in patients with PPH (range 22-77%, P<0.05 to P<0.01). None of the HRV measurements correlated with filling pressure measurements. CONCLUSIONS: The increase in pulmonary vascular resistance in heart failure is not the main causal factor behind a decrease in HRV.     

充血性心力衰竭伴室性心动过速患者心率变异与预后的关系

为探讨充血性心力衰竭（ＣＨＦ）患者自主神经张力变化与室性心律失常的关系，我们对ＣＨＦ患者有或与持续性室性心动过速（ＮＳＶＴ），ＣＨＦ患者与正常组各项心率变异（ＨＲＶ）时域指标进行比较。结果：ＣＨＦ组的ＨＲＶ降低，其ＨＲＶ各项指标与患者的ＬＶＥＦ不存在直线相关，死亡者的ＳＤＲＲ、ＳＤＡＮＮ明显低于存活者（Ｐ＜０．００１）；ＣＨＦ有ＮＳＶＴ者与无ＶＴ者ＨＲＶ差异无显著性（Ｐ＞０．０５）。作者认为ＨＲＶ低表示自主神经张力失衡，容易导致猝死。在预测ＣＨＦ患者预后时，ＨＲＶ优于ＬＶＥＦ和ＮＳＶＴ；ＨＲＶ时域指标ＳＤＲＲ、ＳＤＡＮＮ敏感性优于ＰＮＮ５０。     

急性心肌梗死与心率变异的临床观察

为探索急性心肌梗死时心率变异性指标变化规律,测定４４例急性心肌梗死患者的心率变异性时域指标并与５０例正常人进行对比。结果显示：急性心肌梗死患者心率变异明显低于对照组（Ｐ〈０．０５）;前臂心肌梗死者低于非前臂心肌梗死者,且随着心肌酶的升高、心功能下降相应下降,发生心脏事件者明显低于不发生心脏事件者。提示急性心肌梗死早期心率变异性指标明显下降,表明心脏自主神经功能失调。     

Activity of the neurohormonal system and its relationship to autonomic abnormalities in decompensated heart failure.

BACKGROUND: The syndrome of congestive heart failure (CHF) entails complex autonomic and hormonal responses. Profound abnormalities in autonomic function, characterized by sympathetic overactivity and parasympathetic withdrawal, exert direct deleterious effects on the heart and contribute to progressive circulatory failure. We investigated the relationship of heart rate variability (HRV) with levels of neurohormones in plasma. METHODS AND RESULTS: We studied 64 patients admitted to the hospital for treatment of decompensated CHF (mean age, 59 +/- 2 years; New York Heart Association class III [72%] and IV [28%]). Time- and frequency-domain HRV indices were obtained from 24-hour Holter recordings. Neurohormonal activation was assessed by measuring plasma renin activity and aldosterone and norepinephrine levels. In the time domain, norepinephrine correlated negatively with average NN interval (r = -.34; P =.007), SDNN (r = -.35; P =.005), and SDANN (r = -.36; P =.004). In the frequency domain, norepinephrine was negatively associated with the total power (r = -.39; P =.001) and ultralow power (r = -.43; P =.0005). No correlation was found between indices indicative of parasympathetic modulation, except for a borderline correlation with the high-frequency power (r = -.25; P =.048). CONCLUSIONS: Reduced HRV may be associated with increased norepinephrine levels in patients with severe CHF. The ability of long-term HRV parameters to reflect in part the activation of diverse hormonal systems may explain their greater prognostic power for risk stratification in patients with CHF.     

慢性充血性心力衰竭患者心率变异性分析

为探讨心力衰竭（ＣＨＦ）患者心率变异性（ＨＲＶ）的变化规律及其病理生理机制，本文采用时域及频域两种分析方法，对９２例ＣＨＦ患者５１例健康人进行了ＨＲＶ对比分析，并对部分患者进行血浆儿茶酚胺（ＮＥ、Ｅ）浓度测定及ＨＲＶ随访。发现：健康人及ＣＨＦ患者的ＨＲＶ有明显的昼夜变化规律，夜间ＨＲＶ〉白天：ＣＨＦ患者的ＨＲＶ明显低于健康组，且与病情及心功能明显相关，近期死亡者ＨＲＶ降低更加明显；血浆ＮＥ及Ｎ浓度     

Decreased RR interval complexity and loss of circadian rhythm in patients with congestive heart failure

The present study investigated how the RR interval complexity and variability and their circadian rhythms alter for patients with congestive heart failure (CHF). Sixteen patients aged between 41 and 72 years with CHF and 20 control subjects were included. 24-h ambulatory electrocardiographic recordings were analyzed, and digitized data was partitioned into sections of 30-min duration. For each section, time- and frequency-domain indices, and complexity indices of heart rate variability were calculated. For CHF patients, 24-h average values of all indices were significantly decreased. The circadian rhythms of mean RR intervals were preserved and resembled the abnormal circadian rhythms of the low-frequency power. The circadian rhythms of high-frequency power and all complexity indices shown in the normal control were lost. Conclusively, the patients with CHF showed decreased RR interval complexity and loss of its circadian rhythm, in addition to decreased frequency-domain RR interval variability and its abnormal circadian rhythm.     

急性脑出血患者24小时心率变异性变化与动态心电图异常

目的：了解急性脑出血对心脏自主神经活性改变，心电图复极改变和心律失常的影响。方法：检测61例急性大脑半球壳核和额顶颞叶出血患者和39例对照的24h动态心电图，分析其心率变异性变化，心电图复极改变和心律失常。结果：右侧壳核和额顶颞叶出血患者急性期室上性快速心律失常和心房颤动发生率明显增高，左侧壳核和额顶颞叶出血患者急性期心电图ST段降低发生率明显增高，右侧壳核和额顶颞叶出血组心率变异性指标HF，RMSSD，PNN50明显下降和LF／HF明显增高，伴室上性快速心律失常者LF／HF高于无室上性快速心律失常者，HF明显低于无室上性快速心律失常者。结论：左侧和右侧大脑半球出血对心脏的影响不高，岛叶病变在其中起着主要作用。     

Effect of Beta‐Blockade on Autonomic Modulation of Heart Rate and Neurohormonal Profile in Decompensated Heart Failure

Background: One of the putative mechanisms for the salutary effects of beta‐blockers in patients with congestive heart failure (CHF) is their ability to improve autonomic dysfunction. However, patients with profound neurohumoral abnormalities derive little survival benefit from beta‐blockers. The purpose of the current study was to evaluate the effect of beta‐blockers on heart rate variability (HRV) in decompensated CHF. Methods: Time and frequency domain HRV indices were obtained from 24‐hour Holter recordings and compared to assess the role of beta‐blockade in 199 patients (mean age 60 ± 14 years) with decompensated CHF. Neurohormonal differences were assessed by measuring norepinephrine, endothelin‐1, tumor necrosis factor‐a, and interleukin‐6 in a subset of 64 patients. Results: All HRV indices were markedly suppressed but were substantially higher in patients who were on beta‐blockers. Time domain measures of parasympathetic cardiac activity, the percentage of R‐R intervals with > 50 ms variation (4.9 ± 0.6 vs 7.7 ± 1.2%, P = 0.006) and the square root of mean squared differences of successive R‐R intervals (22.7 ± 2.0 vs 31.6 ± 4.1 ms, P = 0.004), were higher in the beta‐blocker group. Spectral analysis revealed that the total power and the ultra‐low frequency power were significantly higher in patients on beta‐blockers (82% and 59%, respectively). The high frequency power, a spectral index of parasympathetic modulation, was 41% higher in the beta‐blocker group (121 ± 25 vs 171 ± 27 ms2, P = 0.02). Norepinephrine and interleukin‐6 levels were substantially lower in patients on beta‐blockers (28% and 61%, respectively). However, these differences did not reach statistical significance. Conclusions: Beta‐blockers improve the impaired cardiac autonomic regulation during high sympathetic stress of decompensated CHF. This effect may play an important role in protecting the myocardium and preventing arrhythmias during transient increases in sympathetic activity. A.N.E. 2001;6(2):98–106     

急性重度脑外伤患者自主神经功能变化的研究

为探讨急性重度脑外伤（ASTBI）患者是否存在自主神经（ANS）功能障碍及其临床意义,对30例ASIBI患者（ASTBI组,GCS评分≤8分）于入院1周内进行24小时心率变异性（HRV）检测,动态心电图分析系统自动计算HRV各项指标（包括时域、频域和非线性分析）,绘制HRV直方图、散点图,并与31例正常人（对照组）进行比较。结果 ASTBI组HRV多数指标均明显降低（P＜0．05－0．001）;HRV直方图、散点图;均有特 征性改变,存活者和死亡者的HRV时域分析、频域分析各项指标比较有统计学意义。认为HRV能定量、全面、直观地反映ASTBI患者交感神经和迷走神经的功能状态;ASTBI患者存在明显的ANS功能障碍;ANS功能障碍与病情严重性呈正相关,且常直接影响预后。