黄连素与钙剂联用治疗长间歇病态窦房结综合征8例

目的:观察黄连素和钙剂伍用治疗以长间歇(平均为4·33s)为特征的病态窦房结综合征疗效。方法:符合病窦综合征诊断患者8例,口服黄连素片0·4~0·6g,tid;谷维素0·06g,tid;1周后同时加用10%葡萄糖酸钙10ml加入5%葡萄糖或0·9%氯化钠溶液中稀释,静脉滴注8~10d。治疗前后分别作动态心电图检查,观察24h平均心率、24h总心搏数、≥2s长间歇持续时间、长间歇发生次数。结果:治疗后24h平均心率、24h总心搏数,分别由(53·0±11·27)次/min、(71972±25840)次增加至(56·75±6·11)次/min、(76875±15116)次,均P<0·05;≥2s长间歇持续时间、长间歇发生次数分别由(4·33±1·61)s、(2485±2916)次减少至(2·75±0·8)s,(428±523)次,P<0·05、P<0·01。结论:黄连素和钙剂伍用对窦房结功能的改善有一定作用。     

心先安联合黄连素治疗病态窦房结综合征42例临床观察

目的:观察心先安合用黄连素治疗病态窦房结综合征的临床效果.方法:对42例病态窦房结综合征病人给予10%葡萄糖或0.9%氯化钠250 ml加心先安注射液120 mg静脉输注,每日1次,同时口服黄连素0.5 g,每日3次,连用7 d～10 d.结果:治疗后24 h总心搏数、平均心率均较治疗前有所增高,最长窦性R-R间期、最短窦性R-R间期、≥2 s的长R-R间期均较治疗前有所缩短,长R-R间期发作次数较治疗前有所减少(P＜0.01).结论:心先安与黄连素合用治疗病态窦房结综合征可使窦房结功能有一定的改善,且无明显副作用.     

心先安联合黄连素治疗病态窦房结综合征43例临床观察

目的：观察心先安合用黄连素治疗病态窦房结综合征的临床效果。方法：对42例病态窦房结综合征病人给予10％葡萄糖或0．9％氯化钠250ml加心先安注射液120mg静脉输注，每日1次，同时口服黄连素0．5g，每日3次，连用7d-10d。结果：治疗后24h总心搏数、平均心率均较治疗前有所增高，最长窦性R－R间期、最短窦性R－R间期、≥2s的长R－R间期均较治疗前有所缩短，长R－R间期发作次数较治疗前有所减少（P＜0．01）。结论：心先安与黄连素合用治疗病态窦房结综合征可使窦房结功能有一定的改善，且无明显副作用。     

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.     

美托洛尔和培哚普利对心肌梗死患者自主神经失衡和预后的影响

目的观察心肌梗死(AMI)患者应用美托洛尔、培哚普利后的自主神经失衡的变化及其与预后的关系.方法选择病情、年龄等相匹配的AMI患者随机分为美托洛尔组(n=66)、培哚普利组(n=71)及对照组(n=69).测定三组患者用药前及用药后4周及随访期的24h心率变异性(HRV)、左室射血分数(LVEF)、室性心律失常(室早>1O/h),对比其随访结果.结果(1)服药组的HRV观察指标高于对照组[美托洛尔组正常窦性心搏间期的标准差(SDNN)为(138.5±32.6)ms,相邻心搏间期>50ms的百分数(PNN50)为9.5±1.53,高频功率(HF)为(139.9±33.4)ms2;培哚普利组SDNN(117.3±22.9)ms,PNN509.2±1.6,HF(140.6±20.5)ms2;对照组SDNN(87.4±28.6)ms,PNN506.0±3.5,HF(100.3±21.4)ms2,P<0.05];(2)随访期间服药组的室性心律失常发生率明显低于对照组,美托洛尔组为35.4%,培哚普利组为43.5%,对照组为66.1%,P<O.05;(3)服药组患者的HRV恢复比对照组较早、较快;(4)服药组的EF值正常率高于对照组,美托洛尔组EF为96%,培哚普利组EF为90%,对照组EF为64%,P<0.05;(5)对照组的病死率明显高于服药组,分别为美托洛尔组病死率为10%,培哚普利组为22%,对照组为36%,P<0.05.结论美托洛尔和培哚普利能够使AMI及恢复期心肌梗死患者的HRV升高,改善失衡的自主神经功能及降低的心功能,减少室性心律失常发生率,降低病死率.     

不典型文氏型房室传导阻滞并房窦二度逆传阻滞1例

患者女性,16岁.临床诊断:病毒性心肌炎.心电图Ⅱ导联连续记录(图1)示:窦性心律,P-P间期略不规则,P波频率约83次/min,P-R间期逐次延长,分别为0.15、0.17、0.18、0.20s,延至0.20s后重复1～3次心搏,P-R间期不变(0.20s),其后随以长R-R间期,长间期短于两个窦性周期.P-R间期增量未见逐渐减小,因而R-R间期亦不呈逐渐缩短,在中行后部分     

幽门螺杆菌cagⅡ对胃上皮细胞IL-8基因转录的影响及机制

目的探讨HpcagⅡ对胃上皮细胞IL-8基因转录的影响及信号传导机制。方法构建 cagⅡ基因位点缺失Hp突变株及带有IL-8报告基因的人胃癌细胞系L5F11,用液体闪烁计数仪测定荧光素酶(IL8转录)活性,用ELISA法测定IL8蛋白浓度。结果所有Hp突变株诱导荧光素酶活性与IL8蛋白浓度较亲代菌株26695均降低[(0．13±0．01)×cpm比(0．59±0．05)×(P<0．01);(0．73±0．13)ng／ml比(2．22±0．65)ng／ml,(P<0．05)]。PTK抑制剂herbimycinA不仅抑制Hp诱导的荧光素酶活性[(0．71±0．18)×cpm比(1．51±0．23)×cpm,(P<0．05)],而且抑制IL-8蛋白表达[(0．83±0．41)ng／ml比(3．22±0．59)ng／ml,(P<0．05)],但herbimycinA对TNFα诱导的荧光素酶活性及IL8蛋白表达均无影响(P均>0．05);PKA抑制剂H7抑制TNFα诱导的荧光素酶活性[(0．74±0．16)×cpm比(2．62±0．26)×cpm,(P<0．001)]及IL8蛋白表达[(1．45±0．38)ng／ml比(4．12±0．43)ng／ml,(P<0．01)],而对Hp诱导的荧光素酶活性无影响(P>0．05)。结论HpcagⅡ中的多基因能够调节胃上皮细胞IL-8基因转录,且这一作用主要经蛋白酪氨酸激酶途径。     

50名健康人胃电参数及其影响因素的研究

目的测定健康人胃电图(electrogastrography,EGG)参数,研究皮肤阻抗、电极位置不同对EGG参数的影响。方法50名正常体型(体重指数BMI为22．5kg／m2±2．3kg／m2)健康志愿者,5h胃排空X线检查正常。应用双电极DigtrapperEGG,电极置于腹部X线定位胃体窦的体表投影位置。记录时间为餐前0．5h、餐后1h,试餐460KJ。其中各有10名健康人在皮肤阻抗大于和小于10KΩ及X线和标准位置(脐与剑突连线中点旁开45°)分别放置电极进行餐前0．5h的EGG检查。结果健康人餐后EGG主频(DF)和主功率(DP)升高(P<0．05),餐后餐前功率比(PR)为2．7±0．2。主频不稳定系数(DFIC)餐后较餐前降低(P<0．05)。餐前正常节律百分比(85．2±1．7)％,餐后(86．0±2．1)％。皮肤阻抗大于10KΩ胃电正常节律百分比为(36．1±5．5)％,小于10KΩ为(89．6±3．4)％(P<0．001)。X线与标准位置的正常节律百分比为(81．8±3．2)％和(85．5±3．9)％(P>0．05)。结论EGG检查信噪比(皮肤阻抗)是主要的影响因素之一,皮肤准备在EGG检查中十分重要。正常体型EGG检查可不必用超声或X线定位而直接选择标准位置。     

Ⅹ综合征患者心率变异性分析

目的:分析X综合征患者的时域指标,探讨自主神经功能与X综合征之间的关系。方法:对X综合征组、冠心病组、对照组患者进行24h动态心电图监测,分析测定24h连续正常R-R间期的标准差、24h连续每5min节段的正常R-R间期的标准差的平均数、24h连续每5min节段的正常R-R间期的标准差、24h连续正常R-R间期差值均方的平均根(r MSSD)、2个相邻R-R间期互差>50ms的心跳数占所分析信息间期心搏数的百分比(PNN50)等指标情况。结果:X综合征组、冠心病组各指标与对照组比较,除冠心病组r MSSD、PNN50P<0·01以外,其余均P<0·05;X综合征组、冠心病组比较差异无统计学意义。结论:X综合征患者存在心血管自主神经系统功能调节不平衡现象,以交感神经活动占优势。     

窦性心率震荡对急性脑梗死患者预后的影响

目的探讨窦性心率震荡对急性脑梗死患者死亡的预测价值。方法回顾性分析急性脑梗死患者98例与对照组30例、急性脑梗死存活组75例与死亡组23例的24h动态心电图，比较各组间HRT的TO和TS结果（1）与对照组TO、TS（-6．1±3．7％、13．1±5．6ms／R-R间期）比较，急性脑梗死组TO高（-3．2％±6．3％）、TS低（6．1±6．0ms／R-R间期），差异均有显著性意义（P〈0．05、〈0．01）。（2）与急性脑梗死存活组TO、TS（-5．2±5．7％、7．0±2．1ms／R-R间期）比较，死亡组TO值高（-2．2±4．3％）、TS低（5．4±4．0ms／R-R间期），差异均有显著性意义（P〈0．05）。结论HRT与急性脯樟死患者的死亡及预后有关．可作为急性脑梗死患者预后的预测因子。     

The total heart beats per 24 hours by ambulatory electrocardiography and the changes of heart rate by treadmill exercise test in sick sinus syndrome

To study the clinical implications of the total number of heart beats per 24 hours (THB), 24 hour ambulatory electrocardiography and treadmill test were performed by sixty patients with sick sinus syndrome (SSS, 58 +/- 12 years old) who underwent overdrive suppression test. Results were compared with thirty control subjects (58 +/- 12 years old). The THB was 74 +/- 11 thousand beats in the SSS group and 99 +/- 10 thousand beats in the control group. The THB and the maximal heart rate (MHR) achieved during the treadmill test were significantly lower in the SSS group than in the control group. However, the exercise duration in patients with SSS was similar to that of the control subjects. The exercise duration and the MHR were correlated to age, but not to the THB in the patients with SSS. There was no significant relationship between the total heart beats per 24 hours and the maximal sinus node recovery time (max. SNRT). We conclude that the THB, independent of the max. SNRT, can be a useful index in diagnosing and assessing the quantity of bradycardia in patients with SSS. The tolerance of exercise and the MHR were not correlated with the THB, in patients with SSS.     

双腔频率应答起搏对病窦综合征合并的阵发性心房颤动的干预

探讨双腔频率应答起搏对病窦综合征(SSS)合并的阵发性心房颤动(简称房颤)的窦性心律维持及电生理干预。48例SSS并阵发性房颤患者安装了双腔频率应答起搏器,通过起搏器正确的心房感知监测房颤的发作情况,在窦性心律时测量P波时限和P波离散度,心脏B超测量左房内径、左室射血分数。比较术后1,12个月以及房颤控制组与复发组上述指标的差异。结果:置入起搏器术后1年,房颤控制和房颤负荷减少37例,占77%。术后1个月与1年左房内径,P波时限,房颤平均每天发作时间、发作次数均有显著性差异(3.6±0.6cmvs3.2±0.5cm,129.2±11.0msvs111.2±9.3ms,93.6±10.4min/dvs42.8±9.6min/d,8.1±3.2次/天vs5.3±1.4次/天,P<0.001)。与术后房颤复发组比较,房颤控制组术前左房内径较小,P波时限较短、离散度小(P<0.001)。结论:双腔频率应答起搏对SSS合并的阵发性房颤有预防和治疗作用。     

Overdrive suppression in diagnosis of sick sinus syndrome.

A criterion to determine the indication for pacemaker implantation in the sick sinus syndrome by overdrive suppression is proposed. Overdrive suppression was performed in 10 patients with the sick sinus syndrome (SSS) and another 10 patients with normal sinus rhythm (NSR) who served as controls. In the SSS group, 9 patients had complained of such severe symptoms as Adams-Stokes attack and/or congestive failure and were referred to our laboratory for pacemaker implantation. One other patient, an apparently robust young man (20 years old) referred for detailed cardiac examination, had no remarkable symptoms except for arrhythmias, but was found dead two months later. Atrial pacing for overdrive suppression was carried out at first at various rates ranging from 60 to 180 beats/min for 15 sec, and then at a rate of 100 beats/min for various durations ranging from 5 to 180 sec. After cessation of the atrial pacing, asystolic pauses were measured and the maximum (maximum pause) among the pauses obtained was used as a parameter indicating depression of cardiac automaticity. The maximum pause in the SSS group ranged from 5.6 to 9.0 sec (mean +/- SD = 7.0 +/- 1.2), WHILE THOSE IN THE NSR group ranged from 0.7 to 1.5 sec (mean +/- SD = 1.2 +/- 0.14). Therefore, the maximum pause was considered not only to reflect the severity of the symptoms necessitating pacemaker implantation in the 9 patients of the SSS group but to have warned us of sudder death in another patient. We concluded that overdrive suppression is useful as a supplementary challenge to determine indications for pacemaker implantation for the sick sinus syndrome, and that prolongation of the maximum pause beyond 5.0 sec is the critical level for pacemaker implantation.     

阿托伐他汀对植入双腔心脏起搏器的病态窦房结综合征患者左心室重构的影响

目的:探讨阿托伐他汀对植入双腔心脏起搏器(DDD)的病态窦房结综合征(SSS)患者左心室重构的影响。方法:选择在本院心血管内科住院并行DDD植入术的SSS患者108例为研究对象,随机分为常规治疗组(54例,起搏器植入后给予常规抗心律失常药物治疗)和阿托伐他汀组(54例,在常规治疗基础上给予阿托伐他汀治疗)。6个月后,比较两组手术前后左心室重塑指标、心功能指标、心房高频事件(AHREs)发作次数、AHREs持续时间等变化,同时记录治疗期间不良反应。结果:术后6个月,与常规治疗组比较,阿托伐他汀组左室射血分数(LVEF)[(63.91±5.12)%比(65.84±4.85)%]显著提高,LVEDd[(44.26±4.05)mm比(42.48±3.84)mm]和LVESd[(30.89±3.17)mm比(29.31±2.84)mm]显著减小(P<0.05或<0.01);血浆BNP[(127.84±30.84)pg/ml比(98.18±25.95)pg/ml]和NT-proBNP[(313.57±61.56)pg/ml比(269.46±54.48)pg/ml]水平显著降低(P均=0.001);AHREs发作次数[(285.38±45.54)次/年比(263.36±51.28)次/年]和AHREs时间[(17.32±7.54)h/年比(12.74±7.32)h/年]均显著减少(P<0.05或<0.01)。两组治疗期间均未出现肌溶解、转氨酶显著升高(3倍以上)等不良反应。结论:阿托伐他汀可逆转双腔心脏起搏器植入术后病态窦房结综合征患者左心室重构,提高心功能,减少术后心房颤动的发生,且安全性高。     

普罗布考对2型糖尿病大鼠肾脏硫氧还蛋白系统表达的影响

目的 观察硫氧还蛋白系统在2型糖尿病大鼠肾脏组织的表达及早期普罗布考干预对硫氧还蛋白系统表达的影响.方法 将30只雄性SD大鼠分为正常对照组(C组)、糖尿病组(D组)、糖尿病普罗布考治疗组(P组),普罗布考干预8周后,通过免疫组化、RT-PCR、Western免疫印迹技术观察普罗布考对硫氧还蛋白(Thioredoxin,Trx)及硫氧还蛋白相互作用蛋白(Thioredoxin-interacting protein,Txnip)表达的影响,并检测各组大鼠空腹血糖(FPG)、胰岛素、肾功能、丙二醛、超氧化物歧化酶(Superoxide dismutase,SOD)、过氧化氢酶(Catalase,CAT)的含量.结果 P组与C组比较,Trx表达明显降低(0.162±0.008对0.239±0.006,P＜0.05),Txnip表达明显升高(0.159±0.003对0.091±0.016,P＜0.05).P组与D组比较,Trx表达升高(0.162±0.008对0.108±0.013,P＜0.05),Txnip表达降低(0.159±0.003对0.236±0.009,P＜0.05).与C组比较,D组大鼠氧化应激指标升高、肾功能受损、抗氧化酶降低,而P组大鼠上述指标(除FPG外)有所改善(P＜0.05).结论 普罗布考通过部分恢复Trx功能,降低Txnip表达,减少氧化应激,发挥对2型糖尿病大鼠肾脏组织的保护作用.

Abstract：

Objective To observe the expression of thioredoxin (Trx) and thioredoxin-interacting protein (Txnip) in the kidney of type 2 diabetic rats induced by streptozotocin and the effect of probucol treatment on thioredoxin system. Methods Thirty male SD rats were divided into control group( C, n = 10), diabetes group ( D, n =10), and probucol treated diabetic group ( P, n = 10). After eight weeks of probucol treatment, the expressions of Trx and Txnip in the kidney of three groups were measured by RT-PCR, Western blot, and immunohistochemistry. Body weight,24 h microalbuminuria( ALB), fasting plasma glucose( FPG), fasting insulin( HNS), blood urea nitrogen (BUN), creatinine (Cr), malondialdehyde ( MDA ), superoxide dismutase ( SOD ), and catalase (CAT) were determined. Results Compared with group C, Trx was markedly decreased in group P (0. 162 ±0. 008 vs 0. 239 ±0. 006, P＜0.05 ), while Txnip was significantly increased (0. 159±0.003 vs 0. 091 ±0.016, P＜0.05 ). Trx in group P was increased as compared with group D (0. 162 ±0. 008 vs 0. 108 ± 0. 013, P ＜ 0. 05 ), while Txnip was lowered (0. 159±0.003 vs 0. 236±0.009 ,P＜0.05 ). FPG, 24 h ALB, BUN, Cr,and MDA levels in group D were markedly increased as compared with group C (P＜0. 05), while the activity of SOD, CAT, and FINS levels were decreased apparently (P＜0.05). The above markers except for FPG in group P were ameliorated (P＜0. 05 ).Conclusions Probucol attenuated oxidative stress by means of partially restoring Trx function and reducing Txnip expression, and thus played a major role in renoprotection of type 2 diabetic nephropathy.     

缬沙坦对病窦综合征双腔起搏术后阵发性心房颤动的影响

目的评价缬沙坦对病窦综合征(SSS)双腔起搏后阵发性心房颤动(AF)的作用。方法双腔起搏器植入术的患者,术后随访时选出有阵发性AF者81例,将其随机分为治疗组(n=41)和对照组(n=40)。在治疗基础疾病的基础上,治疗组给予缬沙坦80 mg,每晚顿服,对照组不予血管紧张素Ⅱ受体阻滞剂类药物治疗。随访1年,观察AF发作次数、AF负荷及左房内径。结果治疗组起搏术后1年AF发作次数、AF负荷、左房内径明显低于对照组(4.2±1.9次/天vs 9.5±3.4次/天,0.395±0.285 h/d vs 0.860±0.316 h/d,35.9±2.7 mm vs 40.7±3.8mm,P均<0.05),亦低于用药前(P<0.01),而对照组上述指标无变化。结论缬沙坦可有效抑制SSS双腔起搏后阵发性AF的发生。     

不同剂量瑞舒伐他汀对病窦综合症患者起搏治疗后阵发房颤的影响

目的:观察不同剂量瑞舒伐他汀对病窦综合征(SSS)患者起搏治疗后阵发房颤的影响。方法:选择SSS伴阵发房颤(PAF)患者54例,行双腔起搏治疗后随机分为常规治疗组、瑞舒伐他汀低剂量(低剂量组)和瑞舒伐他汀高剂量(高剂量组),每组18例。12个月疗程后比较3组患者高敏C反应蛋白(hsCRP)水平、左房内径(LAD)和房颤(AF)发生情况。结果:治疗12个月后,与常规治疗组相比,他汀低、高剂量组血浆hsCRP[(4.79±1.62)mg/L比(3.37±1.24)mg/L、(3.31±1.21)mg/L]水平明显降低,AF发生次数[(16.17±4.89)次/年比(7.39±2.68)次/年、(7.44±2.68)次/年]、AF负荷[(30.61±5.65)h/年比(6.33±2.57)h/年、(6.44±2.60)h/年]明显减少,LAD[(40.22±4.91)mm比(36.39±3.29)mm、(36.28±3.53)mm]显著减小(P均<0.05),高、低剂量组疗效上差异无显著性。结论:瑞舒伐他汀可以改善起病窦综合征伴阵发房颤患者双腔起搏治疗后心房重构,减少房颤发生,其疗效与剂量无相关性。     

频率适应性起搏器对病态窦房结综合征患者运动贮量的影响

目的：探讨频率适应性起搏器对老年病态窦房结综合征患者生活质量的影响。方法：经临床，动态心电图和运动试验心电图确诊的病态窦房结综合征患者植入永久房室全能型起搏器（DDD），于起搏器植入术后即刻以及一年后分别程控为非频率适应性起搏器模式和频率适应性起搏器模式（DDDR）。两种模式下起搏器各工作一年，动态心电图检测24h活动时心率变化，限制性活动平板运动试验观察动持续时间，最大起搏频率；超声心动图测定最大运动负荷时每搏量、心排出量。结果DDDR模式下。运动持续时间和最大心排出量较DDD模式明显增加．[（87．32±68．877）s：（275．21±57．99）S，P〈0．001；（167．31±18．28）ml／s：（106．13±14．28）ml／s，P〈0．0013。结论：频率适应性起搏器显著改善老年病态窦房结综合征患者的运动耐量。     

动态心电图对病态窦房结综合征诊断价值的探讨

目的 探讨动态心电图在临床中对病态窦房结综合征的诊断价值。方法 选取160例病态窦房结综合征患者作为试验组,并选取160例健康体检者作为对照组,进行24h动态心电图检查,比较两组的检查结果是否存在差异。结果 试验组24h总心搏数、最高心率、最低心率、24h平均心率均低于对照组(P<0.05),差异有统计学意义;试验组发生窦性心动过缓、窦性停搏、房室阻滞等心律失常的患者数高于对照组(P<0.05),差异有统计学意义。结论 动态心电图是诊断病态窦房结综合征的可靠方法。     

老年慢性阻塞性肺病患者窦性心率震荡及心率变异性的研究

目的 探讨慢性阻塞性肺病(COPD)患者窦性心率震荡(HRT)及心率变异性(HRV)变化及临床意义.方法 临床诊断为COPD老年患者59例,选择同期健康老年人30例为对照组.24 h动态心电图检测各组HRT参数:震荡初始(TO)和震荡斜率(TS)及HRV各项指标,肺功能检测,同时超声心动图测量左心室射血分数(LVEF)、右心房内径(RAD)、右心室内径(RVD)、右心室壁厚度(RVWT)等指标;组间比较且对HRT与HRV指标进行相关性分析.结果 与对照组比较,COPD患者TO值显著增高[(-0.2±1.1)%与(-3.8±2.8)%,t=6.830,P＜0.01],TS值显著下降[(7.0±3.6)与(11.7±6.1)ms/RR,t=3.866,P＜0.01];HRV指标正常R-R间期的标准差(SDNN)、正常R-R间期的标准差的平均值(SDNNI)、SDNNI的标准差(SDANN)、相邻R-R间期之差的均方根值(rMSSD)和正常R-R间期标准差≥50 ms的百分数(PNN50)增加,且随肺动脉压力的增高而恶化.TO与SDANN,rMSDD呈负相关(r=-0.369,P＜0.05;r=-0.472,P＜0.01),TS和SDNN,SDANN,PNN50呈正相关(P＜0.05),与rMSDD无相关性(P＞0.05).结论 COPD患者HRT现象减弱,HRT和HRV变化随患者肺动脉压力的增加而恶化,联合检测对评价COPD患者自主神经功能状态及预后有较高临床价值.

Abstract：

Objective To explore the clinical significance of sinus heart rate turbulence (HRT)and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease(COPD).Methods The 59 moderate to severe COPD patients and 30 healthy subjects were enrolled in this study. The 24-hour holter monitor was used to screen the HRT onset (TO), turbulence slope (TS)and HRV. Pulmonary function tests and echocardiographic examination were performed for measuring left ventricular ejection fraction (LVEF), right atrial dimension (RAD), right ventricular dimension (RVD), right ventricular wall thickness (RVWT). Then all the parameters were compared between NC group and COPD group, and the relationship between HRT and HRV was investigated. Results Compared with control group, TO was significantly increased [(-0.2±1.1) % vs.(-3.8±2.8) %, t=6. 830,P＜0.01] and TS was decreased [(7.0±3.6) ms/RR vs. (11.7±6.1) ms/RR, t =3. 866, P＜0.01] in COPD group. In time domain HRV parameters, normal RR intervallerinin standart deviation(SDNN), standard deviation of normal-to-normal beats index (SDNNi), standard deviation of the averages of normal sinus to normal sinus (SDANN), mean squared differences of the successive RR intervals (rMSDD), fraction of consecutive normal sinus intervals that differ by more than 50 ms (PNN50) were significantly lower in COPD group than in control group(P＜0. 05). TO was negatively correlated with SDANN and rMSDD (r=-0. 369, P＜0. 05; r=-0.472, P＜0.01).TS was positively correlated with SDNN, SDANN and PNN50 (all P＜0.05), but had no correlation with rMSDD (P＞0. 05). Conclusions HRT and HRV are dramatically blunted in COPD patients.Combination of HRV and prognosis. and HRT may be simple and elegant ways for evaluating cardiac autonomic functions.