老年冠心病和扩张型心肌病心率变异性改变对比分析

目的了解冠心病（CAD）和扩张型心肌病（DCM）心率变异性（HRV）改变特点，探讨HRV在评估CAD和DCM病情、预后方面的作用及意义。方法所有121例CAD患者、49例DCM患者及62例正常对照组均行冠状动脉造影和超声心动图检查确定和排除CAD、DCM，所有病例均行24小时动态心电图检查并计算HRV时域各指标：SDNN、SDANNind、SDNNind、rMSSD、PNN50。结果CAD、DCM患者的HRV均比正常对照组明显降低（分别为SDNN：98．8±28．9，75．7±18．9VS137．3±34．2；SDANNind：88．8±27．9，67．3±17．8VS125．6±34．6：SDNNind：39．6±15．1，30．9±8．7VS55．7±18．9；rMSSD：23．4±11．7，22．8±9．8VS33．1±19．7：PNN50：4．4±5．9，3．2±3．9VS10.3±12．9）；DCM患者HRV降低最显著，且显著低于CAD患者；当CAD患者合并高咀压病和糖尿病时，HRV进一步下降，与DCM患者下降程度相同。结论CAD和DCM患者均有不同程度的自主神经功能损害；DCM患者、CAD合并高血压病和糖尿病患者的HRV下降更显著，其自主神经损害更显著。

Comparative analysis of the heart rate variability in the elderly patients with coronary artery disease and dilated cardiomyopathy

Objective To investigate the variability of heart rate variability （HRV） in the elderly patients with coronary artery disease （CAD） and dilated cardiomyopathy （DCM） in order to assess the severity of the patients with CAD and DCM. Methods We performed coronary angiography in all 121 patients with CAD, 49 patients with DCM, and 62 control subjects. Time-domain HRV （SDNN, SDANNind, SDNNind, rMSSD, PNN50） were analyzed in all patients before angiography. Results All time-domain HRV in the patients with CAD and DCM were significantly lower than those in control group, respectively. HRV in the patients with DCM were lower than those with CAD. In the CAD patients, HRV were lowest in the patients coexisting with hypertension and diabetes mellitus. Conclusions The injury of cardiac autonomic nervous system exists in patients with CAD and with DCM, and may be more serious in patients with DCM and CAD coexisting with hypertension and diabetes mellitus.