心率变异性与高血压左室重构关系的研究

目的：心率变异性（ＨＲＶ）分析是反映心脏自主神经活动的一项无创性指标。方法：研究ＨＲＶ在高血压左室重构中的作用，应用ＨＲＶ时域与频域分析法，检测与分析７０例高血压病（ＥＨ）男性患者２４小时ＲＲ间期标准差（ＳＤＮＮ）、心率变异指数（ＨＲＶＩ）及心率功率谱密度（ＰＳＤ）；并采用超声心动图测定相对室壁厚度（ＲＷＴ）与左室重量指数（ＬＶＭＩ）对患者进行左室构型分类。３０例健康男性被同期检测，以作对照。结果：７０ 例ＥＨ 患者被分为正常构型（ＲＷＴ 与ＬＶＭＩ均正常），向心性重构（ＲＷＴ 增加，但ＬＶＭＩ正常），向心性肥厚（ＲＷＴ与ＬＶＭＩ均增加）及离心性肥厚（ＲＷＴ正常，但ＬＶＭＩ增加）四个左室构型组。四组患者ＳＤＮＮ、ＨＲＶＩ、ＰＳＤ的低频（ＬＦ）峰值及其与高频（ＨＦ）峰值之比（ＬＦ／ＨＦ）均较正常人减低，而ＰＳＤ的ＨＦ峰值却均较正常人增高，该ＨＲＶ 变化特征的显著性依上述左室构型顺序呈现进行性增强。结论：交感与副交感神经的双重损害参与了高血压的左室重构机制，且其损害程度可能伴随左室重构过程的进行而加重

Heart Rate Variability and Left Ventricular Geometric Remodeling in Patients with Essential Hypertension

Aim:To study the relationship between heart rate variability (HRV) and left ventricular geometric remodeling in patients with essential hypertension (EH). Methods: Standard deviation of all filtered RR intervals over the length of the analysis(SDNN) and heart rate variation index(HRVI) and heart rate power spectrum density(PSD) were assessed by the time and frequency domain analysis on 24 hour Holter tapes. Left ventricular geometric remodeling were examined by two dimiensional and M mody echocardiography in 70 patients with EH. 30 age and gender matched normal adults served as controls. Results:Four different groups of left ventricular geometric remodeling were identified in 74 patients with EH: (1) Patients had both normal RWT and LVMI(normal left ventricle group, n =28);(2) Increased RWT with normal LVMI(concentric remodeling group, n =14);(3)Increased in both RWT and LVMI (concentric hypertrophy group, n =11); and (4)Increased LVMI with normal RWT(eccentric hypertrophy group, n =17). In patients with EH, SDNN, HRVI,low frequency peak and ratio between low frequency and high frequency were lower;high frequency were higher than that in the control group. The abovementioned characteristics of the HRV were increasingly evident in the order of:normal left ventricle group, concentric remodeling group, concentric hypertrophy group and eccentric hypertrophy group. Conclusion: The impariment of sympathetic and parasympathetic function may be involved in pathogenesis of left ventricular grometric remodoling. The degree of impairment seems to be more and more severe in the modeling process of left ventricular structure.