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目的探讨老年慢性肾脏病(chronic kidney disease,CKD)患者超敏C反应蛋白(hs-CRP)水平与心率变异性(heart rate variability,HRV)的关系。方法根据hs-CRP水平将纳入研究的77例老年CKD患者分为正常组65例、异常组12例。对2组患者人口学特征、实验室结果及24 h动态HRV频谱分析技术的时域及频域结果进行比较分析,并与hs-CRP水平作相关分析。结果 77例CKD患者hs-CRP水平为(2.78±3.99)mg/L,正常组为(1.37±1.07)mg/L,异常组为(9.76±6.18)mg/L。相较于正常组,异常组丙氨酸氨基转移酶、总胆红素及间接胆红素水平均较低(P<0.05)。24 h动态心电图检测结果显示,异常组低频及极低频明显低于正常组,差异有统计学意义(P<0.05)。线性回归分析结果显示,hs-CRP与平均心率(β=-0.513,P<0.05)、24 h内相差>50 ms的相邻窦性心搏间期占窦性心搏间期总数的百分比(p NN50)(β=1.278,P<0.05)、低频(β=-16.682,P<0.05)具有相关性。结论 CKD合并高hs-CRP水平患者HRV的频域分析的各项指标参数均减低,hs-CRP与自主神经病变密切相关,对早期发现自主神经病变有益。
Objective To investigate the relationship between hs-CRP and heart rate variability (HRV) in elderly patients with chronic kidney disease (CKD). Methods According to the level of hs-CRP, 77 elderly CKD patients enrolled in the study were divided into normal group (n = 65) and abnormal group (n = 12). The time-domain and frequency-domain results of demographic characteristics, laboratory results and 24-h dynamic HRV spectrum analysis technique were compared and analyzed with the correlation between hs-CRP level and two groups of patients. Results The hs-CRP levels in 77 patients with CKD were (2.78 ± 3.99) mg / L, (1.37 ± 1.07) mg / L in normal group and (9.76 ± 6.18) mg / L in abnormal group. The levels of alanine aminotransferase, total bilirubin and indirect bilirubin in the abnormal group were lower than those in the normal group (P <0.05). 24 h Holter test showed that the abnormal group of low frequency and very low frequency was significantly lower than the normal group, the difference was statistically significant (P <0.05). The results of linear regression analysis showed that the percentage of adjacent sinus pacing interval between hs-CRP and mean heart rate (β = -0.513, P <0.05) and the difference of> 50 ms within 24 h β = 1.278, P <0.05) and low frequency (β = -16.682, P <0.05). Conclusions The parameters of frequency domain analysis of HRV in CKD patients with high hs-CRP level are reduced. Hs-CRP is closely related to autonomic neuropathy, which is beneficial to the early detection of autonomic neuropathy.