Ⅱ型糖尿病患者心率变异时域分析的临床价值探讨

对60例Ⅱ型糖尿病患者HRV时域分析各项指标（SDNN、SDSD、SDANN、RMSSD及PNN50）进行了测定，并与60例正常成人进行对比分析。结果显示Ⅱ型糖尿病患者HRV各项时域分析指标均明显低于正常对照组（P＜0．01）。表明HRV各项时域指标的测定，有利于评价Ⅱ型糖尿病患者的自主神经病变。     

焦虑抑郁心理与高血压患者心率变异性的相关性分析

目的探讨焦虑、抑郁心理与原发性高血压患者心率变异性（HRV）的关系。方法对46例原发性高血压患者运用Zung焦虑自评量表和抑郁自评量表进行心理测评,同时检测其HRV时域分析指标并作相关性分析。结果原发性高血压患者的焦虑自评和抑郁自评分值与其HRV各时域分析指标呈负相关关系。结论焦虑抑郁心理可能导致原发性高血压患者的自主神经功能进一步紊乱,HRV随之减低。     

心率变异评价2型糖尿病合并高血压患者的自主神经功能

目的通过检测心率变异（HRV）探讨2型糖尿病合并高血压患者的自主神经功能变化。方法选择确诊2型糖尿病无高血压的24例住院患者为2型糖尿病组（T2DM）,2型糖尿病合并高血压的患者22例为T2DM并高血压组（T2DM-HT）,非糖尿病、高血压病的住院患者20例为对照组（Con）,全部患者进行24 h动态心电图及HRV分析。结果 T2DM及T2DM-HT组患者HRV的各时域指标均小于对照组（P〈0.05）,而与T2DM组相比,T2DM-HT组患者HRV各时域指标进一步降低（P〈0.05）。结论 T2DM患者存在HRV的降低,而高血压则进一步加重HRV的降低,提示高血压促进T2DM患者自主神经病变的发生发展。     

原发性高血压患者心率变异性的临床分析

目的：探讨原发性高血压（EH）患者自主神经功能变化。方法：对43例原发性高血压患者和20例正常人进行Holter记录，分析对比心率变异性（heart rate variability,HRV)指标。结果：EH患者HRV的时域指标（SDNN、SDNNi、RMSSD）及频域指标（TP、LF、HF）较正常对照均明显降低（P＜0．001－0．05），以RMSSD、HF降低最为显著。EH患者LF／HF较正常对照明显升高（P＜0．05），SDANN与对照组比较差异无显著性（P＞0．05）。EH患者中，重度高血压组的时域、频域的多项指标较轻、中度高血压组降低（P＜0．01－0．05）。极高危组的HRV多项指标亦较非极高危组减低（P＜0．01－0．05）。结论：原发性高血压患者存在迷走神经活性明显降低，同时伴有交感神经活性的相对增强。HRV的减低可能为预后不良的一个重要指标。     

焦虑抑郁心理与高血压患者心率变异性的相关性分析

目的 探讨焦虑、抑郁心理与原发性高血压患者心率变异性(HRV)的关系.方法 对46例原发性高血压患者运用Zung焦虑自评量表和抑郁自评量表进行心理测评,同时检测其HRV时域分析指标并作相关性分析.结果 原发性高血压患者的焦虑自评和抑郁自评分值与其HRV各时域分析指标呈负相关关系.结论 焦虑抑郁心理可能导致原发性高血压患者的自主神经功能进一步紊乱,HRV随之减低.     

慢性肾炎患者心率变异性分析

目的：分析慢性肾炎患者心率变异性（HRV）的改变及其意义。方法：对20名健康人、40例慢性肾炎血压正常患者及加例慢性肾炎高血压患者进行24小时动态心电图监测，分析其HRV的时域指标。结果：慢性肾炎患者的HRV时域指标SDNN、SDANN、SDNNI、RMSSD及PNN抽明显低于正常对照组（P〈0．05），高血压组与血压正常组比较HRV时域指标显著下降（P〈0.05）。结论：慢性肾炎患者HRV降低，自主神经调节功能下降，慢性肾炎存在高血压者下降更严重。慢性肾炎治疗中应注意改善患者的HRV。     

2型糖尿病合并高血压患者的心率变异性特点

目的：探讨2型糖尿病（DM）合并原发性高血压患者（EH）自主神经功能变化和心率变异（HRV）特点.方法：随机选取本中心就诊的30例DM病人为DM组,30例EH病人为EH组,30例DM＋EH病人为DM＋EH组,30例健康人为对照组,分别行24 h动态心电图记录,分析HRV时域和频域指标,对各组HRV指标进行比较研究.结果：EH组中反映交感神经张力的HRV指标数值升高,反映迷走神经张力的HRV指标数值降低,与对照组之间有明显变化（P＜0.05）;DM组、DM＋EH组中反映交感神经和迷走神经张力的HRV指标数值均明显降低,其中DM＋EH组的HRV指标数值降低最为明显,与对照组比较差异有统计学意义（P＜0.05）.结论：EH组、DM组较对照组存在自主神经功能受损害.DM＋EH组较对照组自主神经功能受损害程度更加明显,发生心源性猝死的危险性增加,应定期检查,密切随访.     

用动态心电图对高血压病、脑梗塞的心率变异性探讨

目的：探讨高血压病、脑梗塞发生与发展同（心率变异性）（HBV）变化的关系。方法：采用随机抽样方法对32名高血压病，31名高血压合并脑梗塞的患者进行DCG（动态心电图检查），对HRV的各参数进行统计学处理和t检验。结果：高血压病、脑梗塞患者HRV各项指标均有轻度或中度减低；脑梗塞患者HRV比高血压病患者HRV更为严重降低，两者有显著差别。结论：HRV是预测心脑血管病人靶器官损害和死亡的独立的危险因子。     

原发性高血压伴与不伴左心室肥厚60例心率变异性分析

目的　探讨原发性高血压伴与不伴左心室肥厚的自主神经功能变化。方法　 2 8例原发性高血压伴左心室肥厚 ( L VH)患者、 32例单纯高血压患者及 30例健康对照组进行 2 4小时动态心电图监测 ,所有检查者监测时间均大于 2 3小时 ,并测定心率变异性 ( HRV)时域分析指标 2 4小时 SDNN、SDANN、r MSSD、PNN5 0及昼夜 SDNN、r MSSD、 PNN5 0。结果　高血压伴左心室肥厚组 ( L VH组 ) HRV指标较单纯高血压组和对照组显著低 ( P<0 .0 0 1) ;单纯高血压组 HRV各项指标亦较对照组低 ( P<0 .0 1)。 SDNN、 r MSSD、 PNN5 0在对照组有明显的昼夜节律 ,表现为白天维持低值 ,夜间明显上升 ;单纯高血压组与对照组相似 ,L VH组昼夜节律消失 ,结论　原发性高血压患者 HRV降低 ,自主神经功能受损 ,伴左心室肥厚患者自主神经功能进一步受损 ,昼夜节律消失     

2型糖尿病与原发性高血压患者心律失常和心率变异性分析

目的:分析2型糖尿病与原发性高血压病患者心律失常和心率变异性的特点。方法:选取健康体检者(对照组)46例、2型糖尿病患者(T2DM组)45例、原发性高血压患者(HP组)46例及同时患有2型糖尿病和原发性高血压患者(T2DM+HP组)46例,进行24h长程心电图检查,对其进行心律失常及心率变异性时域分析。结果:(1)心律失常分析:T2DM组、HP组和T2DM+HP组的心律失常(房性早搏、室性早搏)发生率、缺血性ST-T改变明显高于对照组,差异有统计学意义;而T2DM组、HP组和T2DM+HP组的组间比较,心律失常、缺血性ST-T改变差异无统计学意义;(2)心率变异性时域(HRV)分析:T2DM组、HP组和T2DM+HP组各项指标均低于对照组,差异有统计学意义;T2DM组、HP组和T2DM+HP组的组间各项指标比较,差异无统计学意义。结论:2型糖尿病和高血压病均可并发自主神经功能损害,使心律失常、心肌缺血发生率增高,心率变异性(HRV)可作为此类疾病监测自主神经损害的无创检查指标,指导早期的干预治疗。     

Effect of aldose reductase inhibition on heart rate variability in patients with severe or moderate diabetic autonomic neuropathy

Patients with diabetic autonomic neuropathy (DAN) have an increased cardiovascular mortality rate compared with diabetic patients without DAN. Heart rate variability (HRV) time and frequency domain indices are strong predictors of malignant arrhythmias and sudden cardiac death. This prospective, randomised, double-blind, placebo-controlled study analysed the long-term effect of an aldose reductase inhibitor, tolrestat, on HRV time and frequency domain variables in 45 patients with diabetes mellitus (DM) and DAN. Patients were randomised into tolrestat (n = 22) and placebo (n = 23) groups. Tolrestat (200 mg/day) or placebo were administered, respectively, for a period of 12 months. HRV was assessed at months 0, 3, 6, 9 and 12. The HRV level of the 45 patients was compared with that of 20 patients with DM, with analogous glycaemic control, without DAN and 20 healthy controls, of similar age and gender. At the twelfth month, tolrestat, compared with placebo, had a beneficial effect on HRV indices related to vagal tone. Compared with baseline, HRV time and frequency domain indices showed no significant improvement. Moreover, at the twelfth month of tolrestat administration, HRV indices remained less than that of patients with DM but without DAN, and healthy controls. The 12 patients of the 22 with moderate DAN benefited more than the 10 patients of the 22 with severe DAN. At the twelfth month no patient showed deterioration in HRV indices with tolrestat as was seen with placebo. Our data suggest that tolrestat slows down the progression of DAN compared with placebo. This effect of an aldose reductase inhibitor may contribute to a reduction in risk for malignant ventricular arrhythmias. The early detection of DAN is imperative for successful intervention.     

老年2型糖尿病心脏自主神经功能与心率变异性关系的研究

目的探讨耱尿病患者的心率变异性(HRV)及其在诊断自主神经病变(ANP)方面的意义。方法设观察组(糖尿病组)和对照组(非糖尿病组)各30例。两组均测定时域分析的各参数。结果糖尿病组的心率变异性比非糖尿病组显著降低。结论检测糖尿病的心率变异性可早期敏感诊断老年2型糖尿病患者心脏自主神经功能病变。     

Heart rate variability in normotensive subjects with family history of hypertension

Hypertension (HT) is a major silent disease affecting young people because of their hereditary and modern lifestyles. Target organ damages occur before overt hypertension is diagnosed. Many offspring of HT parents show early changes in their cardiovascular autonomic functions. Heart rate variability (HRV) provides a window to understand the cardiac autonomic balance. This study was designed to quantify and to compare the HRV among the normotensive young male offspring without history of parenteral hypertension & diabetic (control group, n = 25, age 20.8 +/- 2.4, BMI 24.4 +/- 3.1) with parenteral history of hypertension & non diabetic (study group n = 25, age 19.7 +/- 1.9, 24.05 +/- 3.5). Blood pressure, heart rate (HR), indices of short term HRV during supine rest and quiet standing, HR variation during timed controlled deep breathing was compared between the two groups. There were significant difference in low frequency (LF) power, HF power, total power. LF and HF expressed also in normalized units at rest and standing. In time domain standard deviation of normal to normal RR interval (SDNN) at supine rest and standing were significant. Respiratory sinus arrthymia (RSA), HF in normalized units, deep breathing difference (BDD) and the ratio of maximum RR to minimum RR were also significant in the control group than study group. In the present study there was an increased sympathetic and decreased parasympathetic activity in the study group. These findings are an early marker of cardiovascular autonomic impairment in subjects with parenteral history of hypertension.     

慢性肺原性心脏病心率变异性时域分析

目的通过心率变异性 (HRV)时域分析评估慢性肺原性心脏病患者心脏自主神经功能损害。方法采用清华 -西安兰港监测系统对 2 5例慢性肺心病急性加重期患者和 5 2例正常人进行2 4小时动态心电图监测及HRV时域分析。结果肺心病组HRV各项指标SDNN、SDSD、RMSSD及PNN5 0均明显低于正常对照组 (P <0 0 1)。结论慢性肺心病患者心脏自主神经功能严重受损 ,HRV时域分析可作为一种无创性评价慢性肺心病患者心脏自主神经功能的可靠方法     

广泛性焦虑患者心率变异性昼夜变化的临床分析

目的探讨广泛性焦虑（GAD）患者心率变异性（HRV）昼夜节律变化。方法选取43例GAD患者为研究组,43例健康成人为对照组,两组均进行24 h动态心电图监测及HRV分析。结果研究组各项HRV时域指标均明显低于对照组,差异有统计学意义（P〈0.05）,研究组白天与夜间SDNN、SDANN、rMSSD、PNN50比较,差异无统计学意义（P〉0.05）。对照组白天与夜间比较,四个指标差异均有显著统计学意义（P〈0.01）。结论 GAD患者存在自主神经功能紊乱,昼夜节律性消失,以迷走神经张力下降,交感神经张力相对亢进为主要表现。     

Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjects

The purpose of the present study was to determine whether readily measured blood pressure (BP) indices and, responses to autonomic reflex tests could be used as surrogates of short-term heart rate variability (HRV), which is an established marker of autonomic regulation of SA node. Therefore, we examined the correlation between short-term HRV and heart rate (HR), BP indices viz. systolic pressure, diastolic pressure, pulse pressure (PP), and rate-pressure product (RPP), during supine rest and head-up tilt in 17 young healthy normotensive subjects, aged 19.8 +/- 1 yr (mean +/- SD). Three classic autonomic indices viz. Valsalva ratio, HR response to deep breathing and pressor response to isometric handgrip were also determined. We noted two interesting and statistically significant (P < 0.05 in both cases) correlations viz. i) a positive correlation (r = 0.6) between change in RPP during tilt and change in low frequency (LF) RR spectral power expressed in normalized units (LF nu) during tilt, and ii) a negative correlation (r = -0.6) between change in PP during isometric handgrip and LF nu during tilt. The possible physiologic significance of these and other correlations is discussed in this paper. In conclusion, the presence of a statistically significant correlation between RPP, PP and spectral measures of short-term HRV supports a simplistic approach to autonomic assessment, in that, easily measurable BP indices could be used as surrogates of HRV when it is not feasible to determine HRV indices directly. However, the same have to be tested in healthy subjects belonging to various age groups and in patients with conditions known to be associated with autonomic dysregulation.     

高血压病并发冠心病患者的心率变异性与心律失常分析

目的 探讨高血压病并发冠心病患者的自主神经活动和心律失常的特点.方法 对52例原发性高血压(EH)患者、44例冠心病(CHD)患者和56例EH并发CHD患者与34例健康老年人的心率变异性(HRV)进行对比研究.结果 EH组和CHD组与对照组HRV时域法所有参数差异均有显著性(P＜0.05);EH并发CHD组与对照组比较,各参数差异均有非常显著意义(P＜0.01);但不同疾病组间比较,差异均无显著性(P＞0.05).3个疾病组与对照组比较,房性早搏、房性心动过速和室性早搏的发生率均有极显著性差异(P＜0.01);而EH组、CHD组及EH CHD组间,除外CHD组与EH CHD组房性早搏的发生率有显著性差异外(P＜0.05),其余差异均无显著性.结论 高血压病患者和冠心病患者的自主神经功能受损,心律失常发生率增加(以房性早搏最常见,其次为室性早搏);当高血压病患者并发冠心病时这种受损更加明显,其迷走神经张力降低,交感神经紧张性相对增高是导致老年患者心率变异性降低的主要原因和心律失常的可能因素.     

高血压合并冠心病患者的心率变异性分析

目的 探讨高血压并发冠心病患者的心率变异性和心律失常的特点.方法 对50例原发性高血压(EH)患者、44例冠心病(CHD)患者和52例EH并发CHD患者与35例健康老年人的心率变异性(HRV)进行对比研究.结果 EH组和CHD组与对照组HRV时域法所有参数差异均有统计学意义(P＜0.05);EH并发CHD组与对照组比较,各参数差异均有统计学意义(P＜0.01);但不同疾病组间比较,差异均无统计学意义(P＞0.05).三个疾病组与对照组比较,房性期前收缩、房性心动过速和室性期前收缩的发生率差异均有统计学意义(P＜0.01);而EH组、CHD组及EH+CHD组间,除外CHD组与EH+CHD组房性期前收缩的发生率差异有统计学意义(P＜0.05)外,其余差异均无统计学意义.结论 高血压患者和冠心病患者的自主神经功能受损,心律失常发生率增加(以房性期前收缩最常见,其次为室性期前收缩);当高血压患者并发冠心病时这种受损更加明显,其迷走神经张力降低,交感神经紧张性相对增高是导致老年患者心率变异性降低的主要原因和心律失常的可能因素.     

硝苯地平控释片氨氯地平对原发性高血压患者血压和心率变异性的影响

目的 :研究长效二氢吡啶类钙拮抗剂硝苯地平控释片与氨氯地平在治疗原发性高血压时对血压、心率变异性的影响。方法 :40例原发性高血压患者随机分为硝苯地平控释片组 (n=2 0 )及氨氯地平组 (n=2 0 ) ,分别予硝苯地平控释片 30～ 6 0mg/ d或氨氯地平 5～ 10 mg/ d,共 8wk。治疗前后行 HRV检测 ,并做对比分析。结果 :2组经 8wk治疗后血压均非常显著下降 (P<0 .0 1)。 2组治疗前后 HRV时域 6项指标 ,包括平均 R- R间期 (AVGR- R)、平均 R- R间期标准差 (SDAR- R)、平均 R- R间期的变异系数 (CV)、平均 R- R间期标准差的均值 (SD)、平均 R- R间期标准差的标准差 (SDSD)、相邻 R- R间期差值平方根的均值 (rm SASD)及频域 4项指标 ,包括低频 (L F 0 .0 2 5～ 0 .1Hz)、中频 (MF 0 .1～ 0 .2 Hz)、高频 (HF 0 .2～ 0 .3Hz)、低频 /高频 (R:L F/ HF)均无变化 (P>0 .0 5 )。结论 :长效二氢吡啶类钙拮抗剂治疗原发性高血压病 ,在降血压时对心率变异性无不利影响。