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目的探讨老年男性高血压心肌肥厚患者血清总睾酮水平与交感神经兴奋性的关系。方法入选老年男性高血压患者共80例,年龄60～90岁。采用24h动态心电图和心率变异性分析系统行心率变异性时域与频域分析。结果反映交感和迷走神经总的张力大小的时域指标24h内正常窦性心率R-R间期值的标准差(SDNN),在高血压心肌肥厚患者较高血压无心肌肥厚患者明显下降;反映交感神经张力的时域指标24h内连续每5分钟正常R-R间期平均值的标准差(SDANN)与24h内连续每5分钟正常R-R间期标准差的平均值(SDANN index),在高血压心肌肥厚组较高血压无心肌肥厚组明显下降;而反映交感神经张力的低频成分的归一化值(LFnu)与LFnu/高频成分的归一化值(HFnu)频域指标明显升高(均P<0.05)。血清总睾酮水平明显降低[(2.8±0.3)比(5.0±0.2)nmol/L,P<0.05]。血清总睾酮水平与交感神经兴奋性密切相关(均P<0.05),是后者独立危险因素。结论老年男性高血压心肌肥厚患者存在交感神经相对亢进和血清总睾酮水平降低,并且两者间变化密切相关。
Objective To investigate the relationship between serum total testosterone and sympathetic nerve excitability in elderly hypertensive patients with hypertrophy. Methods A total of 80 elderly hypertensive patients were selected, aged 60-90 years. Using 24h Holter and heart rate variability analysis system, the heart rate variability time domain and frequency domain analysis. The results showed that the standard deviation (SDNN) of normal sinus rhythm RR interval value within 24 h of time domain index of sympathetic and vagal total tension was significantly decreased in hypertensive myocardial hypertrophy patients with no hypertrophy of hypertrophic cardiomyopathy; Reflecting the sympathetic tone (SDANN), which is the average of standard RR interval for every 5 minutes in 24h, and SDANN index of normal RR interval for 5 minutes in a row in 24h were significantly higher than those in hypertensive myocardial hypertrophy group Hypotension and no cardiac hypertrophy were significantly decreased; while LFnu and LFnu frequency-domain indices of sympathetic tone were significantly higher (both P <0.05 ). Serum total testosterone levels were significantly lower ([2.8 ± 0.3] vs (5.0 ± 0.2) nmol / L, P <0.05]. Total serum testosterone levels are closely related to sympathetic excitability (all P <0.05), which is an independent risk factor for the latter. Conclusion There is a relative increase of sympathetic tone and serum total testosterone in elderly hypertensive patients with hypertrophy, and their changes are closely related.