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目的探讨职业性哮喘(OA)患者心率变异性(HRV)和窦性心律震荡(HRT)的变化及临床意义。方法以106例OA患者为病例组(根据哮喘分级和病程又分为轻度<5年组、轻度≥5年组、中重度<5年组和中重度≥5年组4个亚组),以30名健康成年人为对照组,采用动态心电图检测HRV和HRT指标并分析比较。结果 24 h HRV时域指标:病例组各亚组24 h正常R-R间期的标准差(SDNN)、每5 min正常R-R间期平均值的标准差(SDANN)、每5 min正常R-R间期标准差的平均值(SDNNindex)均低于对照组(P<0.01),轻度<5年组、中重度<5年组相邻正常R-R间期差值的均方根值(RMSSD),相邻正常R-R间期差值>50 ms的计数占总R-R间期数的百分比(PNN50)均高于对照组(P<0.05或P<0.01),轻度≥5年组、中重度≥5年组RMSSD、PNN50均低于对照组(P<0.05或P<0.01);病例组各亚组SDNN、SDANN、SDNNindex指标比较,轻度≥5年组低于轻度<5年组,中重度≥5年组低于中重度<5年组,中重度<5年组低于轻度<5年组,中重度≥5年组低于轻度≥5年组,差异均有统计学意义(P<0.05或P<0.01);轻度<5年组、轻度≥5年组组内白昼时段SDNN、SDANN、SDNNindex、RMSSD低于夜间时段(P<0.05),中重度<5年组组内白昼时段SDNN、SDANN低于夜间时段(P<0.01)。重度哮喘患者室性早搏≥10个、异常HRT发生率高于对照组和轻度哮喘患者,差异均有统计学意义(P<0.05)。结论 OA患者在缓解期可能存在自主神经功能受损或障碍,并随着病程的延长和病情程度的加重而加重。
Objective To investigate the changes and clinical significance of heart rate variability (HRV) and sinus rhythm (HRT) in patients with occupational asthma (OA). Methods One hundred and sixty patients with OA were selected as the case group (divided into four groups according to their grade and course of asthma: mild <5 years, mild> 5 years, medium and severe <5 years, moderate and severe> 5 years) , 30 healthy adults as control group, the use of dynamic electrocardiogram detection of HRV and HRT indicators and analysis and comparison. Results 24 h HRV time-domain index: standard deviation (SDNN) of 24 h normal RR interval, standard deviation of average RR interval every 5 min (SDANN), normal RR interval every 5 min (SDNNindex) were lower than the control group (P <0.01), RMSSD of the difference between normal RR interval in mild <5 years group, moderate and severe <5 years group, adjacent The percentage of normal RR interval> 50 ms in total RR interval (PNN50) was higher than that in control group (P <0.05 or P <0.01), mild ≥ 5 years group, moderate and severe ≥ 5 years group RMSSD and PNN50 were lower than those in the control group (P <0.05 or P <0.01). SDNN, SDANN and SDNNindex in each subgroup were lower than those in the mild subgroup <5 years, moderate and severe≥5 The patients in the group with less than moderate and severe degree <5 years, those with moderate or severe degree less than 5 years in group <5 years and those with moderate or severe grade> 5 years were lower than those in group with mild> 5 years (P < 0.05 or P <0.01). SDNN, SDANN, SDNNindex and RMSSD of daytime in mild <5years and mild> 5years groups were lower than those in nighttime hours (P <0.05) SDNN and SDANN were lower than night time (P <0.01). Severe asthma patients with ventricular premature beats ≥ 10, abnormal HRT incidence was higher than the control group and mild asthma patients, the difference was statistically significant (P <0.05). Conclusion OA patients may have impaired or obstructive autonomic nervous function during remission, and aggravate with the prolongation of the course of disease and aggravation of the severity of the disease.