动态心电图心率变异性时阈参数对老年冠心病合并高血压自主神经功能改变的诊断价值
The Diagnostic Value of Time Threshold Parameters of Heart Rate Variability in Holter Electrocardiogram for Autonomic Nervous Function Changes in Elderly Patients with Coronary Heart Disease Complicated with Hypertension
苏朝霞 1谢丽锋 1龚辉2
作者信息
- 1. 上海市金山区朱泾社区卫生服务中心全科医疗科,上海 201599
- 2. 复旦大学附属金山医院心血管内科,上海 201508
- 折叠
摘要
目的 探讨动态心电图心率变异性(HRV)时阈参数对老年冠心病(CHD)合并高血压自主神经功能改变的诊断价值.方法 选取2021年1月至2023年6月期间上海市金山区朱泾社区卫生服务中心全科医疗科收治的160例老年冠心病患者,所有患者均进行动态心电图检查,收集患者心率变异性时阈参数.根据是否发生自主神经功能改变分为自主神经紊乱组和自主神经正常组,采用多因素Logistic回归分析法明确影响CHD患者合并高血压发生自主神经功能改变的危险因素,并采用受试者工作特征(ROC)曲线分析HRV时阈参数对老年CHD合并高血压自主神经功能改变的诊断价值.结果 自主神经紊乱组正常R-R间期的标准差(SDNN),每5min正常R-R间期标准差(SDANN),相邻R-R间期差值＞50ms的心搏数占比(PNN50)水平均低于自主神经正常组(P＜0.05);自主神经紊乱组有吸烟史占比及收缩压均高于自主神经正常组(P＜0.05);Logistic回归分析显示,收缩压,SDNN、SDANN、PNN50是影响CHD合并高血压患者发生自主神经功能改变的危险因素(P＜0.05);ROC分析结果显示:SDNN、SDANN、PNN50单独及联合预测自主神经功能改变发生的AUC值(95％CI)分别为 0.704(0.627～0.774)、0.673(0.595～0.745)、0.715(0.595～0.745)、0.862(0.798～0.911),3 者联合预测效能高于各项单独检测(Z=3.150、3.728、2.911,P＜0.05).结论 CHD患者HRV时阈参数异常,其中SDNN、SDANN、PNN50低水平是影响CHD发生的独立危险因素,3者联合对老年冠心病CHD合并高血压患者发生自主神经功能改变具有较高的诊断价值.
Abstract
Objective To investigate the diagnostic value of threshold parameters in heart rate variability(HRV)in elderly patients with coronary heart disease(CHD)complicated with hypertension.Methods From January,2021 to June,2023,160 elderly patients with coronary heart disease were selected from the Department of General Medicine of Zhujing Community Health Service Center,Jinshan District,Shanghai.Holter electrocardiogram was performed in all patients,and the time threshold parameters of heart rate variability were collected.According to whether the autonomic nervous function changes occurred,they were divided into the autonomic nervous disorder group and the autonomic nervous normal group.Multivariate logistic regression analysis was used to identify the risk factors affecting autonomic nervous function changes in CHD patients with hypertension.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of threshold parameters in HRV for autonomic nervous function changes in elderly patients with CHD complicated with hypertension.Results The standard deviation of normal R-R interval(SDNN),the mean standard deviation of normal R-R interval every 5min(SDANN),and the stroke number ratio(PNN50)of adjacent R-R interval difference＞50ms in the autonomic nervous disorder group were lower than those in the normal autonomic nervous disorder group(P＜0.05).The smoking history and systolic blood pressure in the autonomic nervous disorder group were higher than those in the normal autonomic nervous system group(P＜0.05).Logistic regression analysis showed that systolic blood pressure,SDNN,SDANN and PNN50 were risk factors for autonomic nervous function changes in CHD patients with hypertension(P＜0.05).ROC analysis results showed:the AUC values(95％CI)of SDNN,SDANN and PNN50 were 0.704(0.627-0.774),0.673(0.595-0.745),0.715(0.595-0.745)and 0.862(0.798-0.91)respectively.The combined prediction efficiency of the three-marker test was higher than that of each single-marker test(Z=3.150,3.728,2.911,P＜0.05).Conclusion The threshold parameters of HRV in CHD patients were abnormal,and low levels of SDNN,SDANN and PNN50 were independent risk factors for CHD.The combination of the three markers has a high diagnostic value for the changes of autonomic nervous function in elderly patients with CHD and hypertension.
关键词
冠心病/高血压/动态心电图/心率变异性时阈参数/自主神经功能/老年Key words
Coronary heart disease/High blood pressure/Dynamic electrocardiogram/Heart rate variability time threshold parameter/Autonomic nervous function/Senility引用本文复制引用
基金项目
2022年金山区医药卫生科技创新资金项目(2022WS52)
出版年
2024
NETL
NSTL
万方数据