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目的:探讨心率震荡(HRT)对急性冠脉综合征(ACS)患者危险分层的意义。方法:研究对象263例,其中ACS者177例,不稳定型心绞痛(UAP)109例(A组),急性心肌梗死(AMI)68例(B组),门诊健康体检者86例(C组),均行24h动态心电图及超声心动图检查,分别计算HRT的两个参数:震荡起始值(TO)和震荡斜率(TS)。结果:①A组[TO:(0.32±5.40)%,TS:(9.04±7.71)ms/RRI]、B组[TO:(0.32±1.94)%,TS:(8.97±6.77)ms/RRI]分别与C组[TO:(-0.83±5.14)%,TS:(13.81±13.21)ms/RRI]比较,A组、B组TO明显增高(P<0.05),而TS明显降低(P<0.05);②A组与B组比较,B组左室射血分数(LVEF)(0.53±0.12)显著低于A组(0.65±0.08)(P<0.05),左室最大舒张内径(LVD)[(50.47±8.59)cm]大于A组[(48.29±6.93)cm](P<0.05);但TO、TS在组间差异无统计学意义(P>0.05);③ACS患者中,LVEF与TO存在负相关性(r=-0.256,P<0.05),与TS存在正相关性(r=0.187,P<0.05);④ACS患者合并高血压或(和)糖尿病时,HRT异常发生率较正常对照组高(P<0.05)。结论:HRT可以对ACS患者进行危险分层及预后判断;当ACS合并高血压、糖尿病时,自主神经功能受损更加严重。
Objective: To investigate the significance of heart rate turbulence (HRT) in risk stratification of patients with acute coronary syndrome (ACS). Methods: Totally 263 subjects were enrolled in this study, including 177 cases of ACS, 109 cases of unstable angina pectoris (UAP), 68 cases of acute myocardial infarction (AMI) and 86 cases of outpatient physical examination (C) , 24h dynamic electrocardiogram and echocardiography were performed, were calculated HRT two parameters: the initial value of shock (TO) and the oscillation slope (TS). Results: ①TAC (TO: 0.32 ± 5.40)% and TS: (9.04 ± 7.71) ms / RRI in group A and TO: 0.32 ± 1.94% and TS: 8.97 ± 6.77 ms / The levels of TO in group A and group B were significantly higher than those in group C (P <0.05), while TS were significantly lower (P <0.05) in group C compared with those in group C [TO: (- 0.83 ± 5.14)%, TS: (13.81 ± 13.21) ms / ; ② Compared with group B, the left ventricular ejection fraction (LVEF) in group B (0.53 ± 0.12) was significantly lower than that in group A (0.65 ± 0.08) (P <0.05) ± 8.59) cm] was significantly higher in group A than in group A [(48.29 ± 6.93) cm] (P <0.05), but there was no significant difference between TO and TS (P> 0.05) (R = -0.256, P <0.05), and there was a positive correlation with TS (r = 0.187, P <0.05). ④The incidence of HRT abnormalities in ACS patients with hypertension or diabetes mellitus was higher than that in normal controls P <0.05). Conclusion: HRT can stratify risk and prognosis in patients with ACS. Autonomic nerve function is more severely impaired when ACS is associated with hypertension and diabetes mellitus.