摘要
目的 探究肺源性心脏病(PHD)患者动态心电图参数与肺功能的相关性及对不良事件的预测价值.方法 选取PHD患者73例为观察组,并纳入同期健康志愿者42例为对照组,两组均接受24 h动态心电图和肺功能检测;比较入组时两组被检者及观察组患者治疗前、治疗后第7天时24 h动态心电图参数[24 h RR间期标准差(SDNN)、每5 min时段正常RR间期标准差(SDANN)]和肺功能指标[1秒用力呼气容积(FEV1)/用力肺活量(FVC)、FEV1预计百分比(FEVl％)];随访6个月,根据不良事件发生情况将观察组分为预后良好组和预后不良组,比较两组患者临床特征,分析24 h动态心电图参数与肺功能的相关性及其对PHD不良事件的预测价值.结果 观察组入院后SDNN、SDANN、FEV1/FVC、FEVl％低于对照组(P<0.05),73例PHD患者在治疗后第7天时的SDNN、SDANN、FEV1/FVC、FEVl％较治疗前升高(P<0.05);随访6个月,73例PHD患者中有32例出现不良事件,预后不良组急性加重期占比、平均病程均高于预后良好组(P<0.05),预后不良组治疗前、治疗后第7天时SDNN、SDANN、FEV1/FVC、FEVl％均低于预后良好组(P<0.05);Pearson相关分析结果显示,治疗前及治疗后第7天时SDNN、SDANN均与治疗前及治疗后第7天时FEV1/FVC、FEVl％呈正相关(P<0.05);ROC分析结果显示,PHD患者发生不良事件的治疗前、治疗后第7天时SDNN、SDANN的cut-off值分别为72 ms、55 ms、92 ms、91ms,AUC范围在0.702～0.813(P<0.05).结论 PHD患者治疗前及治疗后7 d的SDNN、SDANN与肺功能呈正相关,24 h动态心电图参数对PHD不良事件的具有一定的预测价值.
Abstract
Objective To investigate the correlation between 24 h dynamic electrocardiogram ( ECG ) parameters and lung function and their predictive value for adverse events in patients with pulmonary heart disease (PHD). Methods Seventy-three PHD patients (observation group) and 42 healthy volunteers ( control group) underwent 24 h dynamic ECG and pulmonary function tests. The 24 h dynamic ECG parameters,including the standard deviation of normal-to-normal RR intervals( SDNN ),standard deviation of the averaged normal RR intervals for all 5-minute segments ( SDANN ),forced expiratory volume in 1 second ( FEV1 )/forced vital capacity ( FVC ),and predicted percentage of FEV1 ( FEV1％) were compared between groups at enrollment and before and 7 days after treatment in the observation group. After a 6-month follow-up,the observation group was divided based on adverse events occurrence. Clinical characteristics,correlations,and predictive values were analyzed.Results The SDNN,SDANN,FEV1/FVC,and FEVl％ in observation group were lower than those in control group after admission (P<0.05). After 7 days of treatment,the SDNN,SDANN,FEV1/FVC,and FEVl％ of 73 patients with PHD were higher than those before treatment (P<0.05). During the 6-month follow-up,32 out of 73 PHD patients had adverse events. The proportion of acute exacerbation period and the average course of disease in the poor prognosis group were higher than those in the good prognosis group (P<0.05). SDNN,SDANN,FEV1/FVC,and FEV1％ in the poor prognosis group before treatment and on the 7 th day after treatment were lower than those in the good prognosis group ( P<0.05 ).Pearson correlation analysis showed that SDNN and SDANN were positively correlated with FEV1/FVC and FEV1％ before treatment and on the 7 th day after treatment (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of SDNN and SDANN before treatment and on the 7 th day after treatment for adverse events in PHD patients were 72 ms,55 ms,92 ms,and 91 ms,respectively,and the area under the curve (AUC) ranged from 0.702 to 0.813 (P<0.05). Conclusion SDNN and SDANN before treatment and 7 days after treatment correlate positively with pulmonary function in PHD patients,and 24 h dynamic ECG parameters have predictive value for adverse events in PHD.
基金项目
四川省卫生健康委员会普及应用项目计划(2020SC115)
万方数据