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心力衰竭心率变异能谱及其昼夜规律变化

The Changes of Power Spectral Component of Heart Rate Variability and Its Circadian Rhythm in Heart Failure

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【作者】 高修仁曾群英罗斌谢耀群马虹郑振声段大跃

【Author】 GAO Xiu ren, ZENG Qun ying, LUO Bin, XIE Yao qun, MA Hong, ZHENG Zhen sheng, DUAN Da yue. (Department of Cardiology Heart Center, First Affiliated Hospital, Sun Yat sen University, Guangzhou 510080, China)

【机构】 中山大学附属第一医院心内科中山大学附属第一医院心内科 广东广州510080广东广州510080广东广州510080

【摘要】 【目的】探讨心力衰竭患者心率变异能谱及其昼夜规律的变化以及相关的病理生理基础。【方法】对 4 5例充血性心力衰竭连续病例 (分为NYHA心功能≥Ⅲ级组和心功能Ⅱ级组两组 )与 30例心功能正常组对照研究。采用Holter 2 4h全信息心电记录 ,计算机分析系统对心率变异能谱进行分析。同时用放射免疫法测定各组患者血浆肾素活性及血管紧张素Ⅱ、醛固酮血浆浓度。【结果】①随着心力衰竭加重 ,心率变异低能谱范围逐渐下降 ;Ⅱ级心功能组高能谱范围突然下降 ,与正常心功能组对比差异有显著性 (P <0 0 1) ,与≥Ⅲ级心功能组对比差异无显著性 (P >0 0 5 )。②≥Ⅲ级心功能组心率变异各能谱的昼夜规律消失 ,Ⅱ级心功能组昼夜规律存在。③心力衰竭愈重血浆肾素活性及血管紧张素Ⅱ、醛固酮血浆浓度愈高 ,各组间差异有显著性 (P <0 0 5~ 0 0 1)。【结论】①随着心功能下降与主动脉弓压力反射有关的低能谱范围成分逐渐减少 ,与肾素 血管紧张素 醛固酮系统激活程度一致 ;②在心力衰竭早期阶段 (心功能Ⅱ级组 )与呼吸调节有关的高能谱范围突然下降 ;③各能谱范围的昼夜规律消失是≥Ⅲ级心功能组病人的特征性改变 ,这可能是预后不良的指标之一。

【Abstract】 To explore the changes of power spectral component of heart rate variability and its circadian rhythm in heart failure, and to study the pathophysiological bases for these changes. 45 consecutive patients with chronic congestive heart failure (divided into two groups: ① NYHA heart function ≥Ⅲ class group, ②heart function Ⅱ class group) and 30 normal controls were studied. The whole message of electrocardiogram was recorded by Holter and the power spectral component of heart rate variability was analyzed by computer analysis system. The plasma rennin activation (PRA), angiotensin Ⅱ (Ang Ⅱ), aldosterone (Ald) were detected by radioimmunoassay. ①The lower frequency power spectral component declined gradually according to the severity of heart failure. The high frequency power spectral component declined sharply in patients with class Ⅱ heart function compared with the controls (P<0 01), but there was no significant difference between the two heart failure groups (P>0 05). ②Disappearance of the circadian rhythm in terms of total frequency, lower frequency, high frequency was found in patients with ≥class Ⅲ heart function group. The circadian rhythm in class Ⅱ heart function group was similar to that of the controls ③The elevation of plasma PRA, Ang Ⅱ and Ald levels were positively related to the severity of heart failure (P<0 05~0 01). [Conclusion] ①The lower frequency which is related to the aortic arch barorecepter reflex falls gradually as heart function gets worse, and it is closely related to the activation of RAS system. ②The high frequency power spectral component which is related to respiratory regulation declined sharply in patients with class Ⅱ heart function ③ The disappearance of circadian rhythm of all these power spectral component in patients with heart function ≥class Ⅲ may be one of the characteristics of poor prognosis.

【基金】 卫生部辅助循环基金资助项目 (19963 2 17)
  • 【文献出处】 中山医科大学学报 ,Academic Journal of Sun Yat-sen University of Medical Sciences , 编辑部邮箱 ,2002年06期
  • 【分类号】R541.61
  • 【被引频次】15
  • 【下载频次】93
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