原发性高血压病人心率变异性与动脉硬化的相关性

摘要

目的:研究原发性高血压病人心率变异性(HRV)和动脉硬化的相关性.方法:选择我院原发性高血压患者139例(高血压组),按颈-股脉搏波速度(PWV)≥9m/s 和<9m/s分为异常亚组(74例)和正常亚组(65例),另选择同期来院体检的健康成人60例(健康对照组),比较各组HRV指标、PWV值、颈动脉内膜中层厚度(IMT)及颈动脉斑块数,分析高血压患者上述指标间的相关性.结果:与健康对照组比较,高血压组24h每5min正常RR间期均值的标准差[SDANN, (142.3±21.4)ms比(119.3±16.5)ms]明显减小,低频[LF, (341.7±37.9)Hz比(695.4±43.3) Hz]、高频[HF, (519.1±33.6) Hz比(636.8±39.5)Hz]、LF/HF[(0.6±0.3)比(1.0±0.2)]、PWV[(7.44±0.82) m/s比(11.13±0.65) m/s]及IMT[(1.03±0.24)mm比(1.74±0.41)mm]值明显增加(P均<0.01);高血压组中,与PWV正常亚组比较,PWV异常亚组SDANN明显减小,LF、HF、LF/HF、IMT值及人均颈动脉斑块个数明显增多(P<0.05或<0.01);Pearson相关性分析显示高血压患者中PWV及IMT水平均与SDANN显著负相关(r=-0.713、-0.699,P均<0.01),与LF、HF、LF/HF及颈动脉发现斑块数呈显著正相关(r=0.506~0.935,P均<0.01),且PWV与IMT之间也显著正相关(r=0.883,P=0.001).结论:原发性高血压患者HRV中SDANN、LF、HF、LF/HF指标与动脉硬化程度有显著相关性,在治疗中除降血压外,还应处理与动脉病理性改变有关的HRV等因素.%Objective: To study correlation between heart rate variability (HRV) and arteriosclerosis in patients with essential hypertension (EH).Methods: A total of 139 EH patients from our hospital were enrolled as EH group.According to carotid-femoral pulse wave velocity (PWV), they were divided into normal subgroup (n=65, PWV<9 m/s) and abnormal subgroup (n=74, PWV≥9 m/s).Another 60 healthy adults undergoing physical examination in our hospital during the same period were selected as healthy control group.HRV indexes, PWV, carotid intima-media thickness (IMT) and number of carotid plaques were compared among all groups.Correlation among above indexes were analyzed in EH patients.Results: Compared with healthy control group, there was significant reduction in standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording[SDANN, (142.3±21.4)ms vs.(119.3±16.5)ms], significant rise in low frequency[LF, (341.7±37.9)Hz vs.(695.4±43.3) Hz], high frequency[HF, (519.1±33.6) Hz vs.(636.8±39.5)Hz], LF/HF[(0.6±0.3) vs.(1.0±0.2)], PWV[(7.44±0.82) m/s vs.(11.13±0.65) m/s]and IMT[(1.03±0.24)mm vs.(1.74±0.41)mm]in EH group, P<0.01 all;in EH group, compared with normal PWV subgroup, there was significant reduction in SDANN, and significant rise in LF, HF, LF/HF, IMT and mean number of carotid plaques in abnormal PWV subgroup, P<0.05 or <0.01;Pearson correlation analysis indicated that in EH patients, PWV and IMT were significant inversely correlated with SDANN (r=-0.713,-0.699, P<0.01 both), significant positively correlated with LF, HF, LF/HF and carotid plaques (r=0.506~0.935, P<0.01 all), and PWV was significant positively correlated with IMT (r=0.883, P=0.001).Conclusion: In EH patients, SDANN, LF, HF, LF/HF of HRV are significantly correlated with arteriosclerotic extent.Besides lowering blood pressure , HRV etc.related with artery pathological changs should also be treated.