【作者】 韩卫星；

【导师】 臧桐华；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2002， 硕士

【摘要】 目的 探讨心率变异性(HRV)和非线性分析指标Poincare plot的正常范围及其对心脏病的判断价值。方法 对518例正常人和227例心脏病人进行24h动态心电图监测，计算机处理全部心电信息，计算24h HRV的各项时域分析和非线性分析的指标，进行统计学分析和比较。结果 (1) 24h HRV的绝大多数指标呈非正态分布，应用百分位数确定正常值参考范围比较合理并符合临床实际。(2) 24h HRV的各项指标受年龄影响较大，随年龄增大而减低，部分指标与性别有关，男性HRV高于女性。(3)心脏病人HRV明显低于正常组，不同心脏病变HRV降低程度有所不同，以心肌病变严重的心肌梗死和扩张性心肌病降低最为明显。(4)非线性分析指标(VLI、VAI、DI)与时域分析指标呈现显著的正相关。(5)正常组90％以上为彗星状Poincare plot，心脏病人大多出现非彗星状图形(80.6±2.6％)。(6)Poincare plot图形改变与年龄有关，与性别无关，随年龄增大，非彗星状图形增多。(7)与SDNN比较，Poincare plot散点图的特异度、假阳性率和阳性预测值与SDNN相似，灵敏度、阴性预测值和约登指数均明显增高，假阴性率低，差异有高度显著性。结论：24h HRV能反映心脏病人自主神经功能异常而作为判断罹患心脏病以及病变程度的一个指标，Poincare plot具有直观、敏感、特异、准确、简便实用、不受性别影响的特点，更优于SDNN。更多还原

【Abstract】 AIM: To investigate the normal range of 24-hour Heart Rate Variability(HRV) andPoincare plot, and to evaluate their clinical useful value of diagnosing heart diseases.METHODS: 5l8 normal control persons and 227 cases with heart disease wereundergone by 24h Dynamic ElectrocardiograPh Monitoring(DCG).We a-nalyzed aIl oftheir data and 24h HRV variances including Time domain method and Non-linearanalysis by the computer.RESUTS: (l) The great majority of 24h HRV variances were non-normal distribution,then using percentile to identify the normal range of HRV was reasonable and accordingto clinical conditions to define the normal rage of HRV using Percentile. (2) All of HRVvariances were influenced by age and decreased along with growing up. A part of HRVvariances were related with sex and the variances of male were higher then fema1e. (3)The HRV variances were significantly lower in the heaft disease groups than in thenormal control ones. It was most clear in MyocardiaI Infarction (MI) and DilatedCardiomyopathy(DCM) groups with serious myocardial damage. (4) It was markedpositive correlation between the Non-linear variances (VLI,VAI,DI) and the Timedomain analysis ones. (5) Poincare plot shaPed as Comet form is more than 90% in thenormal controls and as Non-Comet form about 80.6 I 2.6% in the heart disease cases. (6)’I’he change of Poincare plot shaPe was related with age but not with sex. The ration ofNon-Comet form increased with age. (7) Compdring with SDNN, Poincare plot showedsimilar Specificity, False positive and Positive predictive value. But it has statisticalsignifican higher Sensitivity Negative predictive value and Youden’s index, and IowerFalse negative than SDNN.CONCLUSION: 24h HRV is able to reflect the abnormal function of autonomic nerver system, then it can be use to judge someone with or without heart disease and the degrees of the disease. The characteristics of Poincare plot are audio-visual, sensitive, specificity, accuracy, convenient, and not influenced by sex, so it is better than SDNN for clinical usefulness.更多还原