慢性肾脏病非透析患者甲状旁腺素和心率变异性关系的研究

目的探讨慢性肾脏病(CKD)患者甲状旁腺素(PTH)和心率变异性(HRV)之间的关系。方法入选2010年6月至2012年6月间于肾内科住院CKD 3～5期非透析患者158例,收集心率变异性数据、血PTH和临床生化结果并进行分析。结果 158例CKD 3～5期非透析患者中HRV降低112例(70.89%),CKD3、4、5期患者的全程NN间期的标准差(SDNN)、全部相邻NN之差的均方根(RMSSD)、相邻NN之差大于50 ms的个数占总窦性心搏个数的百分比(PNN50)、全程每5 min NN间期平均值的标准差(SDANN)呈递减趋势,PTH和RMSSD、PNN50均呈负相关,血红蛋白、血钠、血钾水平也与HRV指标相关。结论 CKD 3～5期非透析患者HRV下降的比率较高,且随着CKD分期增加,发生HRV下降的比率增加。血PTH水平升高可能主要影响CKD患者的副交感神经系统,从而恶化了心脏自主神经系统的功能。

Study of parathyroid hormone and heart rate variability in patients with chronic kidney disease

Objective To investigate the association between parathyroid hormone（PTH） and heart rate variability（HRV）.Methods A total of 158 patients predialysis with CKD stages 3 ～ 5 were enrolled in this study.The parameters of HRV,PTH and other biochemical indicators were measured and analyzed of all these patients.Results 112（70.89%） predialysis patients with CKD stages 3 ～ 5 had a declined HRV.SDNN,RMSSD,PNN50 and SDANN in patients with CKD stages 3 ～ 5 decreased progressively.RMSSD and PNN50 were correlated negatively with PTH.Hemoglobin,sodium and potassium were also correlated with HRV.Conclusion The rate of declined HRV in predialysis patients with CKD stages 3 ～ 5 was high.With the decline of renal function,the rate of declined HRV became higher.High PTH exerts effect on activity of parasympathetic nerve,accordingly deteriorates total autonomic activity in chronic kidney disease patients.