正常人和急性心肌梗死患者心率震荡斜率的昼夜变化及与心率的相关性

目的观察正常人和急性心肌梗死（AMI）患者心率震荡（HRT）的昼夜变化规律,探讨不同人群心率与震荡斜率（TS）的相关性。方法选择100例AMI患者,平均年龄（60.87±13.72）岁,男66例,女34例;82例正常对照者,平均年龄（59.23±13.31）岁,男54例,女28例。两组均进行24h动态心电图检查,定量测定一昼夜中每小时的平均心率（HR）与TS的均值,采用圆形分布统计分析方法,计算两组TS值在昼夜分布中的高峰时点及集中时段。结果（1）正常对照组TS值在24h分布上有明显的集中趋势,高峰时点为04：34（P〈0.05）,集中时段为21：25～11：41;AMI组TS值在24h分布上无明显集中趋势（P〉0.05）。（2）正常对照组HR与TS呈负相关关系（r=-0.771,P〈0.01）;AMI组HR与TS不存在直线相关关系（r=-0.312,P〉0.05）。结论正常人TS值有昼夜节律性,明显受HR的影响。作为心脏的一个基本生物节律,其主要受自主神经的调控。而AMI患者的这种生物节律性消失,可能与自主神经功能紊乱有关。

Circadian variations of heart turbulence slope and correlation with heart rate in healthy individuals and acute myocardial infarction subjects

Objective To observe circadian variations of heart rate turbulence slope（TS） in healthy individuals and patients with acute myocardial infarction（AMI） , and investigate correlation between heart rate （HR） and TS. Methods 100 patients （ mean age 60.87 ± 13.72,66% male ） and 82 healthy individuals （ mean age 59.23 ±13.31,65.9% male） undergoing 24-hour Holter recordings were studied. Mean HR and TS were calculated for each hour a day, and peak time and aggregation period of TS in circadian distribution were dealed by circular distribution analysis system. Results （1）TS value in 24-hours distribution presented apparent aggregation trend （ peak time in 04： 34, aggregation period in 21 ： 25 - 11 ： 41, P 〈 O. 05 ） in control group and non-significant aggregation period （ P 〉 0. 05 ） in AMI group. （ 2 ） HR arid TS were significantly negative correlated in control group：healthy individuals with high HR had low TS （r = -0. 770, P 〈 0. 001 ） ;but were not correlated in AMI group （ r = - 0. 312, P 〉 0. 05 ）. Conclusions TS in healthy individuals indicated circadian rhythm, influenced obviously by HR. As a basic biological rhythm of heart,TS was mainly controlled by autonomic nerve. Whereas the biological rhythm were diminished in AMI group, which was likely to be related with autonomic nerve functional disorder.