急性冠状动脉综合征患者心率震荡的变化与临床意义

目的观察急性冠状动脉综合征(ACS)患者窦性心率震荡(HRT)的变化以及与冠状动脉病变的相关性。方法分别选择109例确诊为ACS患者(ACS组)和69例心脏正常者(对照组),行24 h动态心电图检查,并计算震荡初始值(TO)和震荡斜率(TS)及心率变异指标。同时检测临床资料和冠状动脉造影结果。并根据心肌酶以及心电图的变化对所有ACS患者分为急性心肌梗死(AMI,AMI亚组,51例)、不稳定性心绞痛(UAP,UAP亚组,58例)。比较各组HRT的差异,并根据冠状动脉造影结果分析HRT与Gensini评分的相关性。结果与对照组比较,ACS组TO明显升高(P0.05),TS明显降低(P0.01)。与UAP亚组比较,AMI亚组患者Gensini评分升高,TS明显降低(P0.05,P0.01)。Pearson相关分析显示,冠状动脉病变程度与TO呈正相关(r=0.23,P0.05),与TS呈负相关(r=-0.46,P0.01)。结论 ACS患者HRT现象明显受损,提示ACS患者的心脏自主神经调节功能下降,并且反映冠状动脉病变程度。

The change and clinical significance of heart rate turbulence in patients with acute coronary syndrome

Objective To observe the change of heart rate turbulence(HRT) and its relation to coronary lesions in patients with acute coronary syndrome(ACS).Methods 109 patients with ACS (ACS group) and 69 healthy persons(control group) were chosen.All the subjects were examined using 24-hour Holter.The value of turbulence onset(TO),turbulence slope(TS) and heart rate variability(HRV) were calculated from Holter records.The clinical information and coronary angiography results were obtained.The patients with ACS were divided into acute myocardial infarction (AMI) group and unstable angina pectoris (UAP) group according to cardiac enzymes and electrocardiogram.Results TO in ACS group was significantly higher than control group (P < 0.05),and TS in ACS group was significantly lower than control group.There was significant difference in TS between AMI group and UAP group (P< 0.01),but there were no differences in HRV and TO between the two groups.TO was positively correlated with severity of coronary lesions, while TS was negatively correlated with severity of coronary lesions by Pearson correlation analysis.Conclusions HRT is significantly blunted in ACS patients.It can evaluate cardiac autonomic nerve function and reflect the severity of coronary lesions in patients with ACS.