老年男性代谢综合征患者心率变异与左心室结构的关系

目的探讨老年男性代谢综合征(MS)患者心率变异与左心室结构的关系。方法选取老年男性191例,分为MS合并高血压组(HMS组)70例,MS组65例,非MS组56例。测定各组血脂、空腹血糖、空腹胰岛素水平,测量身高、体重、腰围、血压,并行动态心电图监测及超声心动图检查。结果与非MS组比较,HMS组和MS组患者心率变异各项指标参数均明显下降,左心室重量、左心室重量指数、左心室后壁厚度明显增加(P<0.05,P<0.01),HMS组较MS组下降更明显(P<0.05)。HMS组和MS组胰岛素抵抗指数与左心室重量指数呈正相关(r=0.478,P<0.01;r=0.412,P<0.01),与标准差平均值指数呈负相关(r=-0.363,P<0.01;r=0.296,P<0.01)。结论老年男性代谢因素对自主神经功能有影响。高血压合并MS患者代谢因素与血流动力学因素一样也可导致左心室重构。胰岛素抵抗是影响左心室重构的独立危险因素。

Association between heart rate variability and left ventricular structure in elderly patients with metabolic syndrome

Objective To explore the relationship between heart rate variability(HRV) and left ventricular structure in elderly patients with metabolic syndrome.Methods 191 men aged 60 - 90 were divided into three groups:Hypertensive MS group(HMS group),70 cases;MS group(65 cases) and non-MS group(56 cases).Serum concentrations of lipids,fasting glucose,fasting insulin were measured.Body height,weight,waist circumference,blood pressure were assessed.All patients were observed by echocardiography.24 h Holter recording and heart rate variability analysis were performed.Results The HRV index were markedly lower in HMS and MS group than in non-MS group(P<0.05,P<0.01).LVMI in HMS group was increased significantly,compared with other groups.SDNN-index were inversely related to HOMA-IR,and LVMI were positively related to HOMA-IR.Conclusion Depressed HRV could reflect the autonomic imbalance in MS patients and were inversely correlated with HOMA-IR.Metabolic factors which are the same to hemodynamic factors in patients can lead to left ventricular remolding.