高血压肝阴虚、肝阳亢型血压昼夜节律与心率变异性相关性研究

摘要

[目的]探讨高血压肝阴虚和肝阳亢型患者血压昼夜节律模式对心率变异性(HRV)指标的影响及其临床意义.[方法]采用主症辨证法将87例高血压患者分为肝阳亢组和肝阴虚组,同期分别作动态血压监测及动态心电图HRV分析.[结果]肝阳亢组呈血压昼夜节律正常(杓型改变),肝阴虚组呈血压昼夜节律消失(非杓形改变).2组患者24 h收缩压和舒张压均值、白昼收缩压和舒张压均值比较差异均无统计学意义(P＞0.05),而夜间收缩压和舒张压均值肝阴虚组高于肝阳亢组(P＜0.05);动态心电图HRV分析中,肝阴虚组全天24 h、日间、夜间等3个时段多项心率变异性指标较肝阳亢组均有明显下降(P＜0.01),此组患者24 h平均动脉压与窦性R-R间期的标准差(SDNN)呈线性负相关,相关系数为-0.408(P＜0.01).[结论]高血压病患者血压昼夜节律异常与HRV减低及其昼夜节律消失密切相关,血压昼夜节律消失与自主神经功能严重受损有关.肝阴虚型高血压患者血压昼夜节律消失,且有一定自主神经功能受损.动态血压和HRV监测值可作为原发性高血压辨证分型的客观指标之一.%Objective To discuss the influence of blood pressure circadian rhythm pattern on the heart rate variability (HRV) of primary hypertensive patients with liver yin deficiency pattern and hyperactive liver yang pattern,and to evaluate the clinical significance.Methods Based on the primary-symptom syndrome differentiation,87 primary hypertensive patients were divided into hyperactive liver yang group and liver yin deficiency group,and ambulatory blood pressure monitoring and dynamic electrocardiogram HRV analysis were carried out in all of the patients simultaneously.Results Normal blood pressure circadian rhythm was presented in hyperactive liver yang group while the blood pressure circadian rhythm disappeared in liver yin deficiency group.There were no significant differences of the 24-hour systolic blood pressure and diastolic blood pressure,or the day mean systolic blood pressure and diastolic blood pressure between the two groups (P＞0.05).However,the differences of the night systolic blood pressure and diastolic blood pressure were significant (P＜0.05),and the values of liver yin deficiency group were higher than those of hyperactive liver yang group.The results of dynamic electrocardiogram HRV analysis showed that most of heart rate variability indexes in liver yin deficiency group were decreased within 24 h through the day,in the day time and at night time (P＜0.01 compared with those in hyperactive liver yang group).The 24-h mean arterial pressure in liver yin deficiency patients was negatively correlated with the standard deviation of normal-to-normal intervals (SDNN),and the correlation coefficient was-0.408 (P＜0.01).Conclusion The abnormality of blood pressure circadian rhythm in primary hypertensive patients is closely related with the decrease of HRV and the disappearance of circadian rhythm,and the disappearance of circadian rhythm is probably related with the serious injury of autonomic nerve function.The blood pressure circadian rhythm disappears in liver yin deficiency hypertensive patients,and the patients have certain autonomic nerve function damage.It is indicated that dynamic blood pressure and HRV value can be used as the objective indexes for the syndrome differentiation of primary hypertension.