扩张型心肌病自主神经功能与心力衰竭的相关性

目的 探讨扩张型心肌病（DCM）自主神经功能受损状况。研究自主神经功能异常与心力衰竭的相关性。方法 采用临床病例对照，DCM组31例与正常人31例根据性别，年龄配对，运用动态心电图和计算机数据处理技术，结合心率变异（HRV）时域与频域分析，评价自主神经功能及平衡，超声心动图测量DCM患者左室射血分数（LVEF），左室短轴缩短率（LVFS）等指标。比较不同程度心衰患者自主神经功能异常程度，计算HRV指标与心超参数的相关性。结果 （1）DCM患者HRV较正常人明显降低。（3）心功能Ⅰ-Ⅱ级患者时域指标与正常人相比已避孕药下降；DCM患者LF/HF比值与LVEF，LVFS间存在中度正相关。结论 DCM患者自主神经功能受损，交感神经及迷走神经活性降低，交感-迷走神经功能平衡失调；这在疾病早期就已出现。HRV异常与心脏收缩功能障碍存在正相关。     

慢性充血性心力衰竭患者心率变异性及其昼夜节律的变化

目的：观察慢性充血性心力衰竭（CHF）患者心率变异性（HRV）昼夜变化,探讨CHF患者心脏自主神经功能改变。方法：采用Holter检测48例CHF患者、32例心功能代偿的心血管病患者及40例健康对照者的HRV时域指标,比较三组间HRV指标差异及昼夜差异。结果：CHF组HRV各时域指标均较对照组显著下降,心功能代偿组SDNN、SDANN和SDNNindex较对照组显著下降,rMSSD和PNN50与对照组无显著差别;CHF组HRV昼夜指标无明显差异。结论：CHF患者心脏自主神经调节功能损害。     

青岛海滨疗养因子结合运动疗法对老年高血压患者心率变异性影响的研究

目的 研究青岛海滨疗养因子结合运动疗法对老年高血压患者心率变异性（HRV）的影响。方法选择50例老年原发性高血压患者给予青岛海滨疗养因子结合运动疗法5周，记录并比较此疗法治疗前后血压和HRV5项时域指标，并与40例老年健康对照组比较。结果与对照组相比，老年高血压患者治疗前HRV5项时域指标均有显著性降低（P〈0．05）。治疗后血压从（20．4±1．1）／（11．7±1．0）kPa下降至（17．7±1．0）／（10．0±1．1）kPa，和治疗前HRV5项时域指标比较均有显著性增高（P〈0．05）。结论老年高血压患者采用青岛疗养因子结合运动疗法可降低血压，同时提高心率变异指标，改善自主神经功能。     

2型糖尿病患者心率变异性的改变及卡托普利对其影响

目的探讨2型糖尿病患者心率变异性(HRV)改变的特征及卡托普利对其影响。方法110例2型糖尿病患者分剐进行24h动态心电图检查并与50例正常人进行比较。110例2型糖尿病患者随机分为常规治疗组和卡托普利组；卡托普利组在常规治疗基础上加卡托普利治疗，观察治疗后1、3和6个月后HRV的变化。结果2型糖尿病患者HRV各项指标与正常对照组相比具有显著性差异。卡托普利组治疗3～6个月后，心率变异频域和时域各项指标均有明显改善。结论2型糖尿病患者HRV降低，自主神经功能受损；卡托普利可改善其自主神经功能。     

肥胖型2型糖尿病患者心率变异性临床分析

目的观察肥胖型2型糖尿病患者和健康体检者心率变异性(heart rate variability,HRV)的差异。方法选取2012年9月—2013年9月我院门诊和住院部收治的肥胖型2型糖尿病50例作为观察组,另选择同期健康体检者60例作为对照组,进行24 h动态心电图监测,收集并比较HRV时域指标和频域指标。结果观察组HRV时域指标和频域指标各参数均显著低于对照组,差异有统计学意义(P0.05或P0.01)。结论肥胖型2型糖尿病患者时域指标和频域指标各参数均较健康体检者降低,提示自主神经功能明显受损。     

冠心病患者心率变异性分析

目的了解冠心病（CHD）患者的心率变异性（HRV）特点,探讨CHD患者自主神经变化的临床意义。方法测定93例CHD患者和49例健康对照者24h心率变异性的时域指标,并进行比较分析。结果CHD组24hHRV指标水平明显低于健康对照组（P〈0．01）,差异有统计学意义。结论CHD患者HRV降低提示心血管自主神经系统功能受损害。     

持续性心房颤动患者心率变异性分析

目的分析持续性心房颤动患者的心率变异性（HRV）指标,探讨自主神经功能的变化在其发病过程中的作用。方法通过动态心电图检查对43例持续性心房颤动患者的HRV长程时域指标及每小时心率指标进行分析并与正常对照组比较。结果房颤组心率变异分析的正常RR间期的标准差、相邻RR之差的均方根、相邻RR之差〉50 ms占窦性心搏的百分数均明显增高,白天最高与最低心率差值及心率平均值与夜间比较差异无统计学意义。结论持续性心房颤动患者存在着明显的自主神经功能失常,是持续性心房颤动发作的重要原因。     

职业性哮喘患者心率变异性分析研究

目的观察职业性哮喘患者心率变异性（heart rate variability,HRV）,从而了解职业性哮喘患者自主神经功能的变化。方法对33例职业性哮喘患者和31例健康者分别进行了短程心率变异性分析,并对两组5min所有窦性心率R—R间期标准差（SDNN）、正常相邻R-R间期差值均方根（RMSSD）比较。结果SDNN、RMSSD哮喘组明显降低,与对照组比较差异有显著意义（P〈0．05）。结论职业性哮喘患者存在自主神经功能紊乱,HRV可作为判断职业性哮喘患者的自主神经功能损害的参考指标。     

家庭干预对冠心病患者心率变异性的影响

目的探讨家庭干预对冠心病患者心率变异性的影响。方法将92例冠心病患者分为2组,对照组46例,进行常规冠心病健康宣教;干预组46例,在常规冠心病健康宣教的同时进行家庭干预,时间1年。对两组患者进行心率功率谱时域和频域分析。结果两组患者心率变异性（HRV）时域及频域指标均有改善;与对照组相比,干预组HRV值改善更为明显,其中R-R间期的标准差、每5分钟R—R间期均值标准差、SDNN的均值、正常相邻R—R间期差值的均方根、正常相邻R—R间期差值〉50ms的百分比均有改善,超低频（VLF）、低频（LF）和高频（HF）改善均有统计学意义（P〈0．05）。结论家庭干预可明显改善冠心病患者的心率变异性。     

原发性高血压患者心率变异性的分析

目的研究原发性高血压患者靶器官损害后心率变异性的改变。方法应用24h动态心电图对325例原发性高血压患者(高血压组)与80例健康体检者(正常对照组)进行心率变异性监测,根据心、肾损害情况,对心率变异性检查结果进行对比分析。结果高血压组患者时域指针及频域指针中的高频成分较正常对照组降低,低频成分较对照组升高(均为P<0.05);原发性高血压伴左心室肥厚与不伴左心室肥厚患者相比,时域指针及频域指针中高频成分降低,低频成分升高(均为P<0.05);原发性高血压伴肾功能不全患者与单纯高血压患者时域指针和频域指针的差异无显著性。结论原发性高血压患者的自主神经功能受损害,且损害程度随血压升高逐渐加重。     

Characteristics and prognosis of normoalbuminuric type 1 diabetic patients

Intervention in type 1 diabetic patients with increased urinary albumin excretion (UAE) represents a great step forward in modern diabetology. At the moment, the consensus calls for antihypertensive treatment in normotensive type 1 diabetic patients with persistent microalbuminuria. However, recent data indicate that substantial pathophysiological changes have already taken place at the microalbuminuric stage. Thus, prevention of progression from normo- to microalbuminuria would be a major clinical turning point. A considerable number of potential risk factors for progression to microalbuminuria have been proposed, among which are blood pressure elevation and disturbancies in circadian blood pressure variation. We performed 24-h ambulatory blood pressure (AMBP) monitoring in 115 normoalbuminuric (UAE < 20 micrograms/min) patients, along with performing an assessment of circadian blood pressure and heart rate (HR) variation and a short-term power spectral analysis of RR interval oscillations. Patients with UAE above the median had significantly higher systolic and diastolic AMBP compared to the low normoalbuminuric group. The difference in blood pressure between the two groups was most pronounced for the night blood pressure (P < 0.01 and 0.02). A positive correlation between UAE and circadian variation (described as diastolic night/day ratio) was present--that is, the higher the normoalbuminuria, the more blunted the night/day ratio. The patients characterized by a combination of high-normal UAE and blunted circadian variation also proved to have significantly higher HbA1c values, higher 24-h mean arterial blood pressure, and lower vagal activity. In conclusion, high-normal UAE, poor metabolic control, and cigarette smoking are at present the only established risk factors for progression from normo- to microalbuminuria. However, new data emphasizes the close relation between blood pressure and albumin excretion. Pathophysiological abnormalities (poorer glycemic control, higher blood pressure, and attenuated vagal activity) tend to cluster in patients characterized by high-normal UAE and blunted circadian variation of blood pressures, and this patient group might constitute a putative high-risk group.     

Heart rate variability and baroreflex sensitivity in bilateral lung transplant recipients

The effects of lung afferents denervation on cardiovascular regulation can be assessed on bilateral lung transplantation patients. The high‐frequency component of heart rate variability is known to be synchronous with breathing frequency. Then, if heart beat is neurally modulated by breathing frequency, we may expect disappearance of high frequency of heart rate variability in bilateral lung transplantation patients. On 11 patients and 11 matching healthy controls, we measured R‐R interval (electrocardiography), blood pressure (Portapres^®) and breathing frequency (ultrasonic device) in supine rest, during 10‐min free breathing, 10‐min cadenced breathing (0·25 Hz) and 5‐min handgrip. We analysed heart rate variability and spontaneous variability of arterial blood pressure, by power spectral analysis, and baroreflex sensitivity, by the sequence method. Concerning heart rate variability, with respect to controls, transplant recipients had lower total power and lower low‐ and high‐frequency power. The low‐frequency/high‐frequency ratio was higher. Concerning systolic, diastolic and mean arterial pressure variability, transplant recipients had lower total power (only for cadenced breathing), low frequency and low‐frequency/high‐frequency ratio during free and cadenced breathing. Baroreflex sensitivity was decreased. Denervated lungs induced strong heart rate variability reduction. The higher low‐frequency/high‐frequency ratio suggested that the total power drop was mostly due to high frequency. These results support the hypothesis that neural modulation from lung afferents contributes to the high frequency of heart rate variability.     

Young men with high-normal blood pressure have lower serum adiponectin,smaller LDL size,and higher elevated heart rate than those with optimal blood pressure

OBJECTIVE: Three measures--heart rate, a global index of the influence of the autonomic nervous system on the heart; circulating concentrations of adiponectin, an adipose-specific protein; and C-reactive protein (CRP), a sensitive marker of inflammation--have been reported to be closely associated with insulin resistance. Patients with borderline hypertension are known to be more insulin resistant and dyslipidemic than those with normal blood pressure (BP). BP can be classified into three categories: optimal, normal, and high-normal. The present study examined whether those with high-normal BP have any of these three conditions as compared with those with optimal BP in young healthy men. RESEARCH DESIGN AND METHODS: Anthropometric, blood pressure, heart rate, and blood tests, including tests for adiponectin and CRP, were conducted in 198 male students, ages 18-26 years, who had fasted overnight. Insulin resistance (IR) and insulin secretion (beta-cell levels) were calculated using the homeostasis model assessment (HOMA), and LDL size was measured by PAGE. RESULTS: Compared with the 90 men who had optimal BP, the 46 men with high-normal BP had increased heart rate, BMI, percent body fat, and serum leptin levels. In addition, they had greater serum insulin, HOMA IR, and beta-cell levels, lower adiponectin levels, and comparable CRP levels. Furthermore, the 46 men with high-normal BP had higher serum triglyceride and apolipoprotein (apo) B levels, and smaller LDL size; however, there was no difference in LDL and HDL cholesterol and apoA-I between men with optimal and high-normal BP. After adjusting for BMI, differences were still significant in serum adiponectin, heart rate, and LDL particle size. As BP rose, there was an increase in heart rate (BMI-adjusted least square means were 63, 65, and 70 bpm in men with optimal, normal, and high-normal BP, respectively; P = 0.005), whereas serum adiponectin (7.5, 6.6, and 6.4 mg/l; P = 0.007) and LDL particle size (271, 269, and 269 A; P = 0.008) decreased. CONCLUSIONS: Young men with high-normal BP have a faster heart rate, lower serum adiponectin levels, and smaller LDL size than men with optimal BP, even after adjustment for BMI. These results suggest the necessity of preventing further development of cardiac and metabolic diseases in young people who have high-normal BP.     

血管回声跟踪技术对正常高值血压伴高脂血症患者颈动脉弹性的研究

目的：探讨血管回声跟踪（Echo tracking,ET）技术检测正常高值血压伴高脂血症患者颈总动脉弹性功能的变化及临床意义。方法：应用ET技术检测51例正常高值血压伴高脂血症患者（Ⅰ组）、62例正常高值血压患者（Ⅱ组）及50例正常人（Ⅲ组）双侧颈总动脉的弹性参数,即弹性系数（β）、僵硬度（Ep）、顺应性（AC）、增大指数（AI）、单点脉搏波传导速度（PWVβ）,并用常规血管超声测量颈动脉内中膜厚度（IMT）,进行对比分析。上述各组常规血管超声扫查未见明显异常。结果：各组左、右侧颈总动脉的各弹性指标比较均无统计学意义（P＞0.05）;Ⅰ组、Ⅱ组颈总动脉β较Ⅲ组明显增高,AC较Ⅲ组明显降低,Ⅰ组与Ⅱ组间的β、AC无明显差异;3组间颈总动脉的Ep、PWVβ比较均有统计学意义（P＜0.05）,AI、IMT比较均无统计学意义（P＞0.05）。结论：正常高值血压伴高脂血症患者颈总动脉弹性明显降低;应用ET技术优于常规超声,能更早的发现颈总动脉弹性改变,为临床及时预防心脑血管疾病的发生提供依据。     

阻塞性睡眠呼吸暂停综合征伴血压升高患者血压、血糖及血脂控制情况

目的调查阻塞性睡眠呼吸暂停综合征(OSAS)伴血压升高患者在不同状态下血压、血糖、血脂控制情况。方法对57例OSAS合并高血压或正常高值患者的血压、血糖、血脂控制水平进行调查和随访,并与患者住院时的血压、血糖、血脂数值进行比较分析。同时对行腭咽成形术治疗的高血压患者手术前后的血压控制情况进行分析。结果 (1)高血压组调查时收缩压(SBP),舒张压(DBP)与住院时SBP及DBP相比明显降低(P<0.05);空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)调查时与住院时相比无差异(P>0.05)。(2)正常高值组调查时SBP、DBP、FBG、TC均较住院时增高(P<0.05);调查时TG与住院时相比无差异(P>0.05)。(3)合并高血压且行OSAS手术治疗的患者手术后SBP、DBP与手术前SBP、DBP比较明显降低(P<0.05)。结论 OSAS合并高血压患者出院后血压得到控制,但血糖和血脂有增高趋势;血压正常高值患者出院后血压、血糖、血脂均有增高趋势;OSAS伴高血压患者手术后血压水平得到改善。     

血管回声跟踪技术对正常高值血压者颈总动脉弹性的研究

目的 探讨血管回声跟踪（ET）技术检测正常高值血压者颈总动脉弹性功能的变化情况及其临床意义.方法 应用ET技术检测63例正常高值血压者（HNBP组）与50例健康成人（正常对照组）双侧颈总动脉的弹性参数,包括弹性系数（β）、僵硬度（Eρ）、顺应性（AC）、增大指数（AI）及单点脉搏波传导速度（PWVβ）,并使用常规血管超声测量颈动脉内-中膜厚度（IMT）,结果进行对比分析.结果 组内双侧颈总动脉的IMT及其各弹性参数比较差异均无统计学意义;两组间上述各指标比较,HNBP组的β、Eρ和PWVβ增高,AC降低,差异均有统计学意义（P 〈 0.01）,AI和IMT无明显变化,差异无统计学意义.结论 正常高值血压者颈总动脉Eρ增加,ET技术能较早发现颈总动脉弹性的改变,对临床早期预防心脑血管疾病的发生具有重要意义.     

多元化健康教育对正常高值血压人群生活方式的影响

目的：探讨多元化健康教育对正常高值血压人群生活方式的影响。方法纳入我院2013年1月至2014年2月100例正常高值血压患者,研究对象按照随机分组方法分成对照组和观察组,对照组采用常规护理方式,观察组采用多元化健康教育模式的干预方式,内容包括鼓励患者低盐低脂饮食、改变不良生活习惯、禁止烟酒、适当运动,在干预第6个月评估各项观察指标,检测内容包括血压、血脂、体重等体检报告,并采取调查分析报告观察正常高值血压后生活方式的改变以了解干预效果,使用HPLP生活方式量表评价两种干预模式对生活质量的影响。结果两组患者干预后6个月收缩压、舒张压、血脂与干预前比较具有统计学差异( P<0．05);干预6个月后观察组总胆固醇、体重指数与干预前比较具有统计学差异,且明显低于对照组(P<0．05),患者的认知行为干预与对照组相比其生活方式的改变、坚持运动人数增多,高盐高脂饮食、吸烟饮酒人数减少,两组间比较具有统计学差异( P<0．05);观察组患者的HPLP 总均分及各维度得分均高于对照组患者,两组比较差异具有统计学意义( P<0．05)。结论通过多元化健康教育能纠正正常高值血压人群的不良生活习惯,提高患者的依从性,改善患者的代谢水平,从而改善患者生活质量。     

正常高值血压：一个需要特别关注的血压阶段

目的探讨正常高值血压概念存在的重要性及早期对之进行干预的必要。方法1992年和2007年,对成都市同一人群（711人）进行了心血管疾病（CVD）危险因素的调查,除去1992年已诊断为高血压的114例患者,将剩余的597人分为正常血压组[〈120／80mmHg（1mmHg=0．133kPa）]和正常高值血压组[收缩压120～139mm／1Hg和（或）舒张压80～89mmHg]。对前后两次资料进行分析以探讨正常高值血压与高血压及相关CVD危险因素的关系。结果1992年正常高值血压组的CVD危险因素水平高于正常血压组,到2007年时这种差别仍存在。正常高值血压组的15年累计高血压发病率（91．2％）远高于正常血压组（22．2％）,差异有统计学意义（P〈0．05）;对血脂及体质量等危险因素进行校正后,正常高值血压仍可预测高血压的形成[HR=5．354,95％CI（4．094,7．002）,P=0．001]。1992年两组人群的CVD患病率差异无统计学意义（P〈0．05）,但15年后正常高值血压组的CVD患病率（6．6％）呈高于正常血压组（3．1％）的趋势（P=0．052）。结论正常高值血压是一个特殊的血压阶段,其更易进展为高血压并持续伴随较高水平的心血管疾病危险因素;为预防相关心血管疾病的发生发展,需要对正常高值血压及相关心血管疾病的危险因素进行早期干预。     

心率变异性、血压变异性与高血压患者血管损伤的相关性分析

[目的]探讨原发性高血压患者的心率变异性、血压变异性与血管损伤的相关性.[方法]回顾性分析2013年6月至2016年6月本院收治的405例原发性高血压患者的临床资料,根据患者臂踝脉波传播速度(baP-WV)将其分为baPWV正常组(baPWV＜14m/s,n=267)和baPWV升高组(baPWV≥14m/s,n=138).监测所有患者24 h动态心电图,应用时域及频域分析患者的心率变异性,监测所有患者动态血压,比较两组患者的心率变异性、血压变异性的相关指标,分析其与血管损伤的相关性.[结果]baPWV正常组患者的每5 min心搏RR间期均值的标准差(SDANN)高于baPWV升高组患者,低频(LF)、高频(HF)、低频/高频比较(LF/HF)、夜间/白天心率比值(nHR/dHR)低于baPWV升高组患者,差异具有统计学意义(P＜0.05).baPWV正常组患者的24h平均脉压(24hPP)、24 h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、白天平均压(dPP)、夜间平均收缩压(nSBP)、24 h收缩压标准差(24hSSD)均低于baPWV升高组患者,夜间收缩压下降率(SBPF)高于baPWV升高组患者,差异具有统计学意义(P＜0.05).LF、LF/HF、nHR/dHR、24hPP和24hSSD与baPWV表现为显著正相关(P＜0.05).[结论]原发性高血压患者的LF、LF/HF、nHR/dHR、24hPP和24hSSD与baPWV表现为显著正相关,说明心率变异性、血压变异性与原发性高血压患者血管损伤显著相关.     

心率变异减低与血压昼夜模式关系的研究

目的 :研究心率变异与血压昼夜模式的关系 ,以及靶器官损害程度。方法 :选择原发性高血压病人 10 0例 ,进行 2 4h动态血压与Holter同步监测 ,结果采用t检验。结果 :杓型组病人昼夜低频(LF )均高于非杓型组(P <0 .0 5 ) ,夜间LF明显高于日间 (P <0 .0 1) ;而非杓型组昼夜LF变化无统计学意义 (P >0 .0 5 )。结论 :杓型病人夜间迷走神经受损 ;非杓型病人日间交感神经受损 ,夜间交感神经、迷走神经双重受损