夜间哮喘患者心率变异性的临床观察

目的观察夜间哮喘患者心率变异性 (HRV)及其自主神经功能的变化。方法选择 4 2例夜间哮喘患者 (哮喘组 )和 4 0例健康对照者 (对照组 )进行前瞻性对照研究 ,记录夜间哮喘患者和健康对照者的 2 4小时动态心电图 ,同时进行频域和时域分析。结果反映迷走神经张力的高频 (HF)和相邻心搏的R R间期之间 >5 0ms的心搏数 (NN50 )计数占总R R间期数的百分比 (pNN50 ) ,夜间哮喘患者均增高 ,与对照组比较有显著性差异 (P <0 .0 1) ;而主要反映交感神经张力的低频 (LF)和每 5分钟正常R R间期标准差的平均值 (SDANN) ,夜间哮喘患者均降低 ,与对照组比较也有显著差异性 (P <0 .0 1)。结论夜间哮喘患者存在自主神经功能紊乱。     

老年2型糖尿病患者心律变异性与尿微量白蛋白相关性分析

【目的】探讨老年2型糖尿病患者心率变异性（HRV）与尿微量白蛋白（UAER）的相关性。【方法】将42例老年2型糖尿病患者根据24小时UAER不同分为糖尿病UAER正常组（22例）和糖尿病UAER升高组（20例）。用24h动态心电图分析其HRV，以此来检测糖尿病患者自主神经功能。【结果】老年2型糖尿病UAER升高组患者的全程内相邻正常窦性心率R—R间期的标准差（SDNN）、全程内每5minR—R间期均值的标准差（SDANN）、相邻正常R—R间期差值的均方根（rMSSD）、相邻正常R—R间期相差〉50ms的个数占总心跳次数的百分比（PNN50）均明显低于UAER正常组老年2型糖尿病患者（P〈0．01）。且UAER与HRV显著负相关。【结论】老年2型糖尿病UAER升高组，HRV的各项指标减低显著，心脏自主自神经损害加重。     

心理护理对急性心肌梗死患者心率变异性的影响

目的 探讨心理护理对急性心肌梗死患者心率变异性(HRV)的影响.方法 将80例急性心肌梗死患者,随机分为A组(常规护理)和B组(常规护理+心望护理)各40例,分别接受不同方式的护理,行Holter检查观察HRV情况.对2组患者进行24h窦性心律HRV时域及频域分析.结果 B组的24h平均RR间期标准差(SDNN)、连续5 min节段平均RR间期的标准差(SDANN)、相邻心搏RR间期差值的均方根(rMSSD)、相邻心搏RR间期＞50ms的百分率(PNN50)、低频(LF)、高频(HF)等HRV指标明显高于A组.结论 心理护理能有效提高HRV,改善缺血心肌的心电不稳定性,稳定患者情绪,降低交感神经张力,可能对预防猝死有一定作用.     

动态心电图在评价2型糖尿病患者心脏自主神经功能中的临床意义表达

探究动态心电图在评价2型糖尿病患者心脏自主神经功能中的临床意义。选取我院和市二院112例2型糖尿病(T2DM)患者,按照传统心血管自主神经功能检查结果分为阴性组73例和阳性组39例。以动态心电图测定两组心脏变时功能、心率震荡(HRT)及心率变异(HRV)等指标水平,分析检测结果。结果阳性组的全天最慢心率高于阴性组,最快心率低于阴性组,最快、最慢心率差值小于阴性组,差异有统计学意义(P0.05);阳性组全程相邻R-R间期差值的均方根值(r MSSD)、全部正常窦性心搏R-R间期的标准差(SDNN)及5min心搏间期均值的标准差(SDANN)等HRV指标低于阴性组,差异有统计学意义(P0.05);阳性组HRT中震荡斜率(TS)值低于阴性组,差异有统计学意义(P0.05),但震荡初始(TO)值组间对比,差异无统计学意义(P0.05)。采用动态心电图对2型糖尿病患者心脏变时功能、心率震荡及心率变异等指标进行记录,能有效评价其心脏自主神经功能。     

充血性心力衰竭患者的心率变异性及其与心功能关系的初步研究

对28例正常人及41例充血性心力衰竭(CHF)患者的24小时动态心电图资料进行分析,得出24小时总心搏、平均心率及以下心率变异性(HRV)指标:24小时正常RR间期标准差(SDNN);24小时内连续的5分钟节段平均正常RR间期标准差(SDANN);24小时内连续的5分钟节段正常RR间期标准差的平均数(SDNN Index),连续正常RR间期差值均方的平方根(rMSSD)及两个相邻正常RR间期差值大于50ms的个数占一定时间RR间期总个数的百分比(pNN50)。结果显示,CHF患者的所有HRV指标均显著低于正常组,且在CHF组中,心功能Ⅲ～Ⅳ级(按NYHA心功能分级标准)患者的SDNN、SDANN及SDNN Index显著低于心功能Ⅱ级的患者。提示CHF患者的HRV降低,心脏自主神经调节能力减弱,且与病情严重程度有关。     

老年2型糖尿病患者心率变异性与血清MMP-9的临床观察

目的 探讨老年2型糖尿病患者心率变异性(heart rate variability,HRV)与血清基质金属蛋白酶-9 (Matrixmetallo proteinase 9,MMP-9)水平变化.方法 选取2010年住院治疗的老年2型糖尿病患者42例,再选取老年非糖尿病患者40例,分为糖尿病组和对照组,并行24 h动态心电图检查,测定HRV,包括窦性心搏R-R(NN)间期的标准差(SDNN)、全程记录中每5 min NN间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(MSSD),检测血清MMP-9指标,并对糖尿病组的HRV与MMP-9行线性相关分析.结果 糖尿病组HRV计数值显著低于对照组(P<0.05),而MMP-9值较对照组显著升高(P<0.05),HRV与MMP-9具有显著的负相关性(r=-0.24,r=-0.18,r=- 0.22,P<0.05).结论 糖尿病患者心脏自主神经功能的改变和MMP-9的变化具有相关性.     

小儿功能性腹痛与自主神经功能异常的关系——附37例报告

目的分析小儿功能性腹痛与心脏自主神经功能异常的关系.方法通过心电图与心率变异性分析系统检测与分析37例功能性腹痛患儿(腹痛组)和30名健康儿童(对照组)的心率变异性.结果腹痛组正常窦性心搏间期的标准差(standard deviation of normal number of intervals,SDNN)、相邻正常窦性心搏间期之差的平方根值(root mean square values of the standard deviation between adjacent normal number of intervals,RMSSD)、相邻正常窦性心搏间期差值超过50 ms的个数占总窦性心搏数的百分率(percentage of differences exceeding 50 ms between adjacent normal number ofintervals,PNN50)、高频功率和低频功率/高频功率与对照组比较差异有统计学意义(P＜0.05～0.01);低频功率2组比较差异无统计学意义(P＞0.05).结论功能性腹痛患儿大部分的HRV指标均有别于正常儿童,提示其功能性腹痛可能与自主神经功能异常有关.     

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。     

慢性肺心病患者的心率变异性

目的：观察慢性肺心病患者心率变异性，了解其自主神经功能的变化。方法：对25例慢性肺心病，25例健康对照者（对照组）作前瞻性对照研究，记录24h动态心电图，作时域和频域分析，结果：与对照组比较，肺心病组相邻心搏的R－R间期之差＞50ms的心搏数占R－R间期数的百分(pNN50)，每5min正常R－R间期标准差的平均值（SDANN），频域指标的高频（HF）明显降低，低频与高频的比值（LF／HF），明显升高，差异均有非常显著意义（P均＜0．01），而频域指标的低频（LF）无明显变化（P＞0．05），经过治疗后，肺心病组处于缓解期，与治疗前比较，HF，PNN50，SDANN等指标明显增加，而LF／HF明显降低，差异均有非常显著意义（P均＜0．01），肺心病组病人治疗后HF，pNN50,SDANN等指标均低于对照组，而LF／HF明显高于对照组，差异均有非常显著意义（P均＜0．01），肺心病组治疗后LF与治疗前及对照组比较，差异不具显著意义（P＞0．05）。结论：肺心中层得不仅交感神经活动占优势，同时并存迷走神经功能受损，自主神经功能可能存在连续性障碍。     

II型糖尿病患者心率变异性分析

目的：了解53例II型糖尿病（NIDDM）和50例正常对照者的心率变异性（HRV）的临床意义，方法：应用24小时动态心电图心率变异频谱分析检查II型糖尿病合并或不合并心脏自主神经病变（ANP）的患者，结果：II型糖尿病24小时R－R间期标准差（SDNN）(ms),相临正常R－R间期差值超过50ms的百分数（PNN50）显著低于正常人，II型糖尿病组R－R间期的总能，高，低频段的幅度均明显低于正常人，结论：HVR是糖尿病心脏自主神经病变（ANP）最敏感而又有效的方法之一。     

Heart rate variability and its determinants in patients with severe or mild essential hypertension

How cardiac autonomic nervous control is related to the severity of essential hypertension in patients receiving long‐term antihypertensive therapy is not well known. The aim of this study was to examine heart rate variability (HRV), a non‐invasive measure of cardiac autonomic function, in patients with long‐term and medically treated mild and severe essential hypertension and healthy control subjects, and to assess the clinical determinants of HRV in these patients. Thirty‐four patients with severe essential hypertension (SEHT) and 29 with mild essential hypertension (MEHT) as well as healthy age‐ and sex‐matched control subjects were studied. HRV was assessed from 10 min ECG‐recordings during paced (0·2 Hz) breathing at rest and expressed as time and frequency domain measures. In the SEHT group time (SDNN, RMSSD) and frequency domain measures (total power, low‐frequency (LF) power and high‐frequency (HF) power of HRV in absolute units, and LF and HF power of HRV in normalized units) of HRV were significantly lower when compared with those of the control group. The MEHT and control groups did not differ from each other with respect to time or frequency domain measures of HRV. Comparison between the hypertensive groups showed that SDNN, total power, LF power and HF power were lower in the SEHT group compared with the MEHT group (P<0·05 for all). Among hypertensive patients RR‐interval, age, gender, systolic finger blood pressure and diastolic office blood pressure as well as 24‐h blood pressure were significant determinants of HRV. In conclusion, we found that the severity of chronic essential hypertension seems to be related to the severity of impairment of cardiac autonomic control.     

Effect of diabetes mellitus on heart rate variability in patients with congestive heart failure

This study sought to determine if the severity of autonomic perturbations in patients with heart failure are affected by the presence of diabetes. Decreased HRV is frequent in diabetic patients free of clinically apparent heart disease and has been invoked as a risk factor for sudden cardiac death. However, reduced HRV is also commonly present in patients with left ventricular dysfunction. The effect of diabetes on autonomic dysfunction in this setting is not known. Holter ECGs from 69 diabetic patients and 85 nondiabetic control subjects with heart failure were analyzed. The severity of autonomic dysfunction was assessed using 24-hour time- and frequency-domain HRV analysis. Prognostically important time- and frequency-domain HRV measures (SDNN, SDANN5, total power, and ultra-low frequency power) were not different between the two groups. Time- and frequency-domain parameters modulated by parasympathetic tone (pNN50, RMSSD, and HF power) were depressed to a similar degree in the diabetic and the nondiabetic groups. The low frequency power was significantly lower in diabetic patients (5.8 +/- 0.7 vs 5.3 +/- 1.0, P = 0.02). The ratio of low to high frequency power was substantially lower in the diabetic group (2.2 +/- 0.2 vs 1.4 +/- 0.2, P < 0.0001). These differences were more apparent in insulin-treated diabetics. In the presence of heart failure, HRV parameters that are most predictive of adverse outcome are similar in diabetic and nondiabetic patients. Furthermore, during increased sympathetic stimulation in the setting of heart failure, diabetes does not worsen parasympathetic withdrawal but may mitigate sympathetic activation.     

甲亢病人的心率变异性及临床意义

目的 :通过对 31例甲状腺机能亢进症 (简称甲亢 )患者 (甲亢组 )和 31例正常人 (对照组 )的心率变异性 (HRV)的分析 ,进一步了解甲亢患者自主神经功能状况。方法 :对甲亢组和对照组进行 2 4hHRV对比分析。结果 :甲亢组与对照组比较其时域指标 :SDNN、SDANN明显降低 ,频域指标 :VLF、LF/HF增高 (P <0 .0 0 1,P <0 .0 5 ) ,LF、HF降低 ,与对照组有显著差异 (P<0 .0 0 1,P <0 .0 5 )。结论 :通过HRV的变化 ,进一步说明甲亢患者的交感神经受损和迷走神经失衡。     

Cardiac sympathovagal balance during sleep apnea episodes

Summary. The main acute cardiovascular effects of obstructive sleep apnea syndrome (OSAS) are elevation of blood pressure and reflectory bradycardia, which are followed by an abrupt tachycardia on resumption of breathing. This haemodynamic instability is related to hypoxemia and arousal, and may lead to increased risk from cardiac arrhythmias and sudden cardiac death, as well as to the development of chronic arterial hypertension, in these patients. The aim of this study was to apply frequency domain analysis of heart rate variability (HRV) measured from continuous electrocardiogram (ECG) recordings to evaluate how cardiac autonomic function, and especially cardiac sympathovagal tone, changes during sleep apnea episodes. We identified 41 apneas leading to more than 4%-unit arterial oxygen desaturation in 12 patients (11 men, 1 women, age range 27–67 years). Frequency domain analysis of HRV was performed from ECG recordings using 4 min epochs starting 20 min before apnea began and lasting 20 min after the beginning of apnea. The mean (± SEM) fall in oxygen saturation during the apnea was 6.8±0.6%-units. While high frequency band (HF, reflects cardiac vagal activity) remained unchanged, low frequency band (LF, mainly sympathetic activity) showed a constant increase, leading to significant change in the sympathovagal balance (LF/HF ratio). In conclusion, concordantly with previous peripheral sympathetic-nerve recordings, frequency domain analysis of HRV is able to detect sympathetic activation during sleep apnea episodes, leading to marked change in the sympathovagal balance.     

Cardiac autonomic dysfunction in diabetic children.

OBJECTIVE: Adults with type 1 diabetes may have abnormal alterations in heart rate variability (HRV) due to cardiac autonomic neuropathy. This prospective study was performed to determine whether HRV can be used to detect subclinical autonomic neuropathy in diabetic children. RESEARCH DESIGN AND METHODS: We examined five time domain and three frequency domain HRV indices determined from 24-h Holter recordings in 73 diabetic children and adolescents aged 3-18 years (mean 12.1 years) with a mean duration of diabetes of 55 months. The measures were compared with normal ranges. Z scores were established for each parameter and were compared with classic risk factors of other diabetic complications. RESULTS: Most HRV indices were significantly depressed in children aged > or = 11 years, and the levels of HRV abnormalities were significantly correlated with long-term metabolic control (mean GHb for 4 years) in that age-group. In younger patients, HRV indices were within the normal range and were not correlated with the level of metabolic control. Illness duration and microalbuminuria but not short-term metabolic control (most recent GHb) were also independently predictive of HRV abnormalities. CONCLUSIONS: These results suggest that early puberty is a critical period for the development of diabetic cardiac autonomic dysfunction. Therefore, all type 1 diabetic patients should be screened for this complication by HRV analysis beginning at the first stage of puberty regardless of illness duration, microalbuminuria, and level of metabolic control.     

Assessment of autonomic nervous system functions in patients with vitamin B12 deficiency by power spectral analysis of heart rate variability

The purpose of this study was to test the autonomic nervous system function of patients with vitamin B12 deficiency (megaloblastic anemia) by measuring heart rate variability (HRV). The study population consisted of 17 vitamin B12 deficient patients and 15 age- and sex-matched normal volunteers. HRV was measured by power spectral analysis from which power of the low frequency (LF) peak (0.04-0.15 Hz), normalized units of the LF peak (LFNU), power of the high frequency (HF) peak (0.15-0.4 Hz), normalized units of the HF (HFNU), and ratio of power of LF to power of HF (LF:HF) were calculated. Vitamin B12 deficient patients had lower LF, LFNU, HF, HFNU, and LF:HF ratio than normal volunteers (P < 0.05). Decreases in sympathetic indices (LF and LFNU) were greater than those measured in parasympathetic indices (HF and HFNU). All HRV parameters correlated positively with the level of vitamin B12 (P < 0.001) and negatively with the duration of disease (P < 0.001). After vitamin B12 replacement the HRV parameters of patients and controls became comparable (P > 0.05). Our data suggest that autonomic sympathetic and parasympathetic nervous activities are decreased in patients with vitamin B12 deficiency, an abnormality that can be corrected by vitamin B12 replacement therapy.     

联合用药治疗糖尿病肾病的疗效观察

目的　寻找及探讨对糖尿病肾病 (DN)有效的干预治疗方法。方法　选择已确诊的糖尿病肾病白蛋白尿 (MA) >30mg/L、血肌酐 (Scr)水平 <2 6 5 μmol/L(≤ 3mg/dl)的病例 16例 ,分为正常肾功能组及异常肾功能组 ,两组分别给予低蛋白饮食、胰岛素、抗血小板集聚、血管紧张素转换酶抑制剂 (ACEI)、抗凝等药物联合治疗 ,3周后复查MA、Scr、2 4h尿蛋白定量 (TP)、血尿素氮 (BUN) ,观察空腹血糖 (FBG)及平均动脉压(MAP)。结果　治疗后正常肾功能组MA、TP明显下降 (P <0 0 1) ,FBG、MAP下降 (P <0 0 5 ) ;异常肾功能组MA、TP、BUN、Scr、FBG下降 (P <0 0 5 ) ,但MA、TP下降幅度小于肾功能正常组 ,MAP无明显变化。结论　联合治疗能够较明显降低DN患者的MA及TP的水平 ,并可改善肾功能异常者的肾脏功能     

Cardiac autonomic nervous dysfunction in diabetic patients with a mitochondrial DNA mutation: assessment by heart rate variability

OBJECTIVE: To elucidate the degree and characteristics of cardiac autonomic nervous dysfunction in diabetic patients associated with a mitochondrial DNA mutation at base pair 3243. RESEARCH DESIGN AND METHODS: We investigated heart rate variability using 24-h Holter monitoring in 10 diabetic patients with the mutation compared with 55 ordinary diabetic patients and 45 nondiabetic control subjects. RESULTS: Age and sex were similar in the three groups. Between patients with the mutation and ordinary diabetic patients, the duration of diabetes and blood glycemic levels were not different. In the time domain analysis of heart rate variability, patients with the mutation and ordinary diabetic patients had significantly smaller SDNN index and pNN50 than control subjects. Compared with ordinary diabetic patients, patients with the mutation had smaller SDNN index (P < 0.02), but rMSSD and pNN50 were not different. In the frequency domain analysis, total, low frequency (LF), and high frequency (HF) spectra were significantly smaller in patients with the mutation and ordinary diabetic patients than in control subjects. Compared with ordinary diabetic patients, patients with the mutation had smaller total and LF spectra (P < 0.02). However, HF spectra were not significantly different. Notably, the LF/HF spectra ratio was lower in patients with the mutation than in ordinary diabetic patients and control subjects (P < 0.05), but this ratio was similar in ordinary diabetic patients and control subjects. CONCLUSIONS: Our results suggest that diabetic patients with the mitochondrial DNA mutation have more severely impaired cardiac autonomic nervous function with sympathovagal imbalance, as compared with ordinary diabetic patients.     

射频消融术对心脏自主神经的影响及其与心肌细胞损伤的关系

目的　观察射频消融术 (RFCA)患者术前、术后心率变异性及血清心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶 (CK MB)的变化 ,探讨RFCA对心脏自主神经的影响以及与心肌细胞损伤的关系。方法　选择 80例接受RFCA治疗的阵发性室上性心动过速患者 ,于术前、术后测定心率变异性 (HRV)及cTnI及CK MB水平。结果　RFCA后R R间期差值均方根 (rMSSD)、R R间期差值 >5 0ms百分率 (PNN50 )、极低频功率谱密度 (VLF)、低频功率谱密度 (LF)、和高频功率谱密度 (HF)明显降低 (P <0 .0 5 )。房室结双径路、间隔旁道及左侧旁道HF较术前有显著性下降 (P <0 .0 5 )。右侧旁道HF、VLF下降 ,但差异无统计学意义。HRV各参数变化与消融能量、消融时间、消融次数及cTnI、CK MB的升高倍数均无显著相关性 (P >0 .0 5 )。结论　射频消融术后心脏交感神经和迷走神经活性均有不同程度的损伤 ,迷走神经损伤较交感神经损伤严重 ,右侧旁道迷走神经受损不明显 ,心脏自主神经损伤与心肌细胞损伤无关。     

Frequency-domain analysis of heart rate variability during positive and negative head-up tilt test: importance of age

The study of autonomic behavior during a head-up tilt test (HUT) has been deemed important to understand the loss of consciousness mechanism. Though HRV in patients with HUT(+) and HUT(-) has been compared, few trials emphasized the importance of age. HRV in frequency domain was analyzed based on 5-minute samples in the supine position, and between 5 and 10 minutes during early tilt test (R1) in 102 patients with one or more episodes of syncope (mean age 44.3 +/- 20.8, range 15-85 years, 55 women). Two subgroups were selected afterwards: (1) young patients between 15 and 35 years of age (41 patients) and (2) elderly patients aged 60 or more (36 patients). The following parameters were taken into account: the sum of low (LF) and high frequency (HF) (LF and HF in absolute values and in normalized units), the LF/HF ratio (L/H ratio), and the percentage of change between baseline and R1 values. The HRV behavior in young and elderly patients with positive and negative HUT was established. We then analyzed the correlation between HRV and age and HUT outcome. A multiple regression analysis encompassing age, HUT outcome, gender, and number of syncope episodes was performed. In young patients, the LF and HF areas and the L/H ratio changed significantly between baseline and R1. The L/H ratio increases from baseline to R1. Conversely, these differences were not significant in the elderly. No differences between HUT(+) and HUT(-) within the same age group were observed. Age related significantly to practically all HRV parameters analyzed, whereas the tilt test outcome correlates poorly with HF normalized units and LF normalized units during R1, and the L/H ratio changes between baseline and R1. By means of a multivariate analysis, only age shows a significant correlation with the HRV values. Despite an all age triggering of vasovagal syncope during HUT, the young and elderly patients' autonomic behavior differs. The young considerably increase their sympathovagal balance during HUT, whereas the elderly have a mitigated autonomic response. No significant differences were observed during the first minutes of the test between those with a HUT(+) and those with a HUT(-) within the same age group. Age, and not the HUT response, is the major determinant of the autonomic behavior during early HUT.