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目的探讨P波离散度(P wave dispersion,Pd)和P波振幅(P wave amplitude,Pa)在高原性心脏病(high altitude heart disease,HAHD)患者的变化及对房性心律失常发生的判断价值。方法收集山南市人民医院住院的HAHD患者87例,根据有无房性心律失常发生,分为房性心律失常组(心律失常组,n=35)与非房性心律失常组(非心律失常组,n=52)。测量最大P波时限(Pmax)与最小P波时限(Pmin),计算Pd;同步测量Pa。动态心电图分析心率变异性(heart rate variability,HRV)频域指标:低频谱功率(LF)、高频谱功率(HF)及其比值(LF/HF)。比较3组Pd、Pa及HRV频域指标。采用多因素Logistic回归分析预测房性心律失常发生的危险性。结果心律失常组Pd显著高于非心律失常组(P<0.05),两组间Pa的差异无统计学意义。心律失常组LF和LF/HF分别高于非心律失常组,HF显著低于非心律失常组(均P<0.05)。Logistic回归分析提示Pd是预测房性心律失常发生的独立危险因素。房性心律失常频率与Pd、LF和LF/HF呈正相关,而与HF呈负相关。结论 HAHD患者Pd增大与房性心律失常的发生密切相关,交感神经显著激活可能在诱发房性心律失常中起主导作用。
Objective To investigate the changes of P wave dispersion (Pd) and P wave amplitude (Pa) in patients with high altitude heart disease (HAHD) and to evaluate the value of atrial arrhythmia . Methods Eighty-seven patients with HAHD in Shannan People’s Hospital were enrolled and divided into atrial arrhythmia group (arrhythmia group, n = 35) and non-atrial arrhythmia group (non-arrhythmia group , n = 52). Measure the maximum P-wave limit (Pmax) and the minimum P-wave limit (Pmin), calculate Pd; measure simultaneously Pa. Holter analysis of heart rate variability (HRV) Frequency domain indicators: low spectral power (LF), high spectral power (HF) and its ratio (LF / HF). The Pd, Pa and HRV frequency domain indexes of three groups were compared. Multivariate logistic regression analysis was used to predict the risk of atrial arrhythmia. Results Pd in arrhythmia group was significantly higher than that in non-arrhythmia group (P <0.05). There was no significant difference in Pa between the two groups. The levels of LF and LF / HF in arrhythmia group were significantly higher than those in non-arrhythmia group, and HF was significantly lower than those in non-arrhythmia group (all P <0.05). Logistic regression analysis suggested that Pd was an independent risk factor for predicting atrial arrhythmia. The frequency of atrial arrhythmia was positively correlated with Pd, LF and LF / HF, but negatively correlated with HF. Conclusions The increase of Pd in patients with HAHD is closely related to the occurrence of atrial arrhythmia. The significant activation of sympathetic nerve may play a leading role in inducing atrial arrhythmia.