急性冠脉综合征患者心率减速力变化特点及其与心率变异性的相关性分析

目的 分析急性冠脉综合征患者（ACS）心率减速力（DC）指标变化特点及其与心率变异性（HRV）的相关性。方法 选取2016年9月至2017年7月期间在安徽医科大学第三附属医院心内科确诊为ACS的119例患者（ACS组）,为研究对象,将ACS组分为不稳定型心绞痛（UAP）组和急性心肌梗死（AMI）组,选择同期本院门诊体检者中年龄、性别相仿并接受动态心电图检查的52例健康者（健康对照组）为对照组,检测两组患者24 h动态心电图,并应用美国DMS公司动态心电图Net版分析系统对两组研究对象24 h动态心电图检查结果进行分析,包括DC指标和HRV时域指标24 h正常RR间期标准差（SDNN）、全程相邻窦性R-R间期之差的均方根值（rMSSD）、相邻正常RR间期差值>50 ms的心搏数占总RR间期数的百分比（PNN50）]。比较3组患者DC、HRV各指标的差异,探讨ACS患者DC和HRV指标相关性。结果 与健康对照组比较,UAP组及AMI组DC值降低,差异有统计学意义（P均<0.05）；UAP组及AMI组DC值差异无统计学意义（P>0.05）。UAP组及AMI组SDNN、rMSSD、PNN50较对照组降低,差异具有统计学意义（P均<0.05）,AMI组SDNN较UAP组降低,差异具有统计学意义（P<0.05）, rMSSD、PNN50差异无统计学意义（P>0.05）。ACS组患者的DC值与SDNN、PNN50、rMSSD的相关系数分别为0.329、0.201、0.187（P均<0.05）,均为正相关。结论 DC可作为定量反映ACS患者迷走神经受损程度的可靠心电学指标。

Characteristics of deceleration capacity of heart rate and its relationship with heart rate variability in patients with acute coronary syndrome

Objective To investigate the characteristics of changes in deceleration capacity (DC) of heart rate and its relationship with heart rate variability (HRV) in those patients with acute coronary syndrome (ACS). Methods 119 patients diagnosed as ACS in our hospital between Sep 2016 and Jul 2017 were enrolled as the study objects (ACS group), and they were further divided into the UAP (unstable angina pectoris) subgroup and AMI (acute myocardial infarction) subgroup. Other 52 age-and gender-matched healthy people receiving medical examinations were selected simultaneously as the control group. All participants in the two groups underwent the 24-hour Holter monitoring and their results were analyzed with the DMS Holter Analysis System (USA), including such indicators as DC and HRV time domain (SDNN, rMSSD and PNN50). Differences of DC and HRV values between the two groups were compared, and furthermore, correlation between DC and HRV values in the ACS patients were analyzed.Results The DC values in the ACS patients were significantly lower than those in the controls (P<0.05), but no significant difference was found between the UAP and AMI subgroups (P>0.05). The values of SDNN, rMSSD and PNN50 in the ACS patients were also significantly lower than those in the control group (all P<0.05). In the AMI subgroup, the SDNN value was lower than that in the UAP subgroup, with significant difference (P<0.05), but there was no significant difference in the rMSSD and PNN50 values between the two subgroups (P>0.05). The correlation coefficients of DC with SDNN, PNN50 and rMSSD in those ACS patients were 0.329, 0.201 and 0.187(all P>0.05), respectively, and their correlations were positive. Conclusion The DC value could be used as a valuable electrocardiological marker for quantitative identification of the degree of vagus nerve injury in those ACS patients.