高血压病心率变异性与临床心血管事件发生的关系的研究

目的:探讨原发性高血压病(EH)伴左室肥厚(LVH)和非左室肥厚(NLVH)的心率变异性(HVR)与临床心血管事件发生之间的关系。方法:90例高血压患者,分为有或无左室肥厚两组及45例正常人作为对照组,分别检测24h动态心电图R-R间期的心率变异性(HRV)时域指标:24h内正常R-R间期的标准差(SDANN);24h内连续5min节段平均正常R-R间期的标准差(SDANN);两个相邻R-R间期差>50ms的心跳数占正常心跳次数的百分比(PNN50);连续R-R间期平方根均值(rMSSD)。随访上述患者心血管事件(CVE)的发生情况。结果:EH伴LVH组的HRV时域指标SDNN、SDANN、rMSSD明显低于EH伴NLVH组及对照组(P<0.01),PNN50明显高于EH伴NLVH组及对照组(P<0.01),随访发现心血管事件发生率在LVH组为51.1%,在NLVH组为26.7%,而健康组为0;发生CVE患者HRV明显低于无CVE者。以SDNN低于70ms及PNN50高于55%为界定值,预测心血管事件发生的敏感性为80%,特异性为71%,阳性预测值为84%。结论:EH伴LVH的发生可能与HRV的减低有关,HRV的减低增加了心血管事件的发生率,对预测心血管事件的发生有一定的临床价值。

STUDY OF THE RELATIONSHIP BETWEEN THE HEART RATE VARIABILITY AND THE INCIDENCE RATE OF CARDIOVASCULAR EVENTS IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective:To analyse the relationship between the heart rate variability (HRV) and the incidence rate of cardiovascular events(CVE) in patients with essential hypertension (EH) complicated by left ventricular hypertrophy (LVH) or non-hypertrophy(NLVH).Methods:By using Holter 24h R-R intervals variability analysis system, the heart rate variability(HRV) including The following time domain measures of HRV were calculated: standard deviation of all normal RR intervals (SDNN), standard deviation of 5-minute mean RR intervals (SDANN), root-mean square of difference of successive RR intervals (rMSSD), percentage of adjacent normal RR intervals >50 ms different (PNN50) were measured and compared in 90 EH patients complicated with LVH and NLVH and 45 normal controls(NC).The incidence of cardiovascular events(CVE)was followed and investigated in all studying subjects.Results:The SDNN and SDANN were significant lower in EH patients than those in normal subjects. SDNN,SDANN and rMSSD were significant lower in patients with LVH than those in EH patients with NLVH , PNN50 was significant lower in patients with LVH than those in EH patients with NLVH and normal subjects ,the incidence rate of CVE in LVH and NLVH was 51.1% and 26.7% . SDNN <70 ms and PNN50 >55% can be used to predict the CVE in EH patients with higher sensitivity 80% , specificity 71%, and postive predictive value 84%.Conclusions:The changed HRV correlates to CVE and has important value for predicting CVE in the patients with EH complicated by left ventricular hypertrophy (LVH) or non-hypertrophy(NLVH)