中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (06): 332-336.doi: 10.3969/j.issn.1671-4091.2015.06.004

• 临床研究 • 上一篇    下一篇

非糖尿病血液透析患者心率变异性与动脉粥样硬化关系的探讨

李忠心1,赵素梅1,李艳春1,孙倩美2   

  1. 1. 首都医科大学附属北京朝阳医院肾内科
    2. 首都医科大学附属北京朝阳医院综合科
  • 收稿日期:2014-12-29 修回日期:2015-03-14 出版日期:2015-06-12 发布日期:2015-05-29
  • 通讯作者: 李忠心 xyjhtoug@sina.com E-mail:cyyylzx@sina.com

The relationship between heart rate variability and atherosclerosis in non-diabetic hemodialysis patients

  • Received:2014-12-29 Revised:2015-03-14 Online:2015-06-12 Published:2015-05-29

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摘要： 【摘要】目的探讨非糖尿病血液透析(MHD)患者心率变异性(HRV)与动脉粥样硬化(AS)的关系。方法108 例非糖尿病MHD 患者于非透析日行彩色多普勒超声检测颈动脉内膜-中层厚度(IMT)及24 小时动态心电图,并通过计算机软件分析获取HRV 指标,并对HRV 指标与颈动脉IMT 进行相关分析。结果①108 例非糖尿病MHD 患者颈动脉IMT[(1.11±0.24)mm 比(0.72±0.17)mm]及斑块阳性率(48%比9%)均明显高于正常对照组(P 均＜0.05); ②非糖尿病MHD 伴AS 组患者HRV 指标分别为SDNN[(64.6±22.4)ms 比(90.5±23.9)ms], SDANN[(66.2±15.9)ms 比(99.2±16.3)ms],RMDSS[(17.6±9.8)ms 比(25.1±10.1)ms], PNN50[(5.4±3.8)% 比(10.3±4.7)%], HRVI [(16.9±5.0)比(25.7±7.9)]明显低于MHD 不伴AS 组HRV 指标,(P 均＜0.05); ③单变量相关分析表明，HRV 指标中SDNN,SDANN,RMDSS,PNN50, HRVI 与颈动脉IMT 呈负相关(t 分别为t=-0.421，-0.381，-0.371，-0.451，-0.397, P 均＜0.05)；④多元逐步回归分析结果显示，HRV 各参数，低密度脂蛋白、收缩压与AS 并发症独立相关。结论非糖尿病MHD 患者自主神经功能紊乱与动脉粥样硬化性心血管并发症密切相关。

关键词: 血液透析, 动脉粥样硬化, 心率变异性, 动脉内膜-中层厚度

Abstract: Objective To determine the relationship between heart rate variability（HRV) and atherosclerosis(AS) in nondiabetic hemodialysis patients(MHD). Methods 108 nondiabetic MHD patients were enrolled in this study . Carotid initial-medial thickness(IMT) was measured by high-resolution B-mode echocardiography and HRV parameters were detected by 24-hour electrocardiogram monitoring on a day without hemodialysis .The relationship between HRV parameters and carotid IMT are analyzed . Results (1)Cartid IMT[(1.11±0.24)mm vs（0.72±0.17）mm ) ]and the prevalence of atherosclerosis plaques(48%vs9%) were significantly higher in108 nondiabetic MHD patients than those in the healthy controls (P＜0.05). (2)SDNN[（64.6±22.4）ms VS（90.5±23.9）ms], SDANN[（66.2±15.9）msVS（99.2±16.3）ms],RMDSS[（17.6±9.8）ms VS（25.1±10.1）ms], PNN50[（5.4±3.8）% VS（10.3±4.7）%],HRVI[（16.9±5.0）VS（25.7±7.9）]of 24hours HRV were significantly lower in nondiabetic MHDwith AS patients than those in the MHD without AS patients.(P＜0.05). (3) Univariate analysis showed that SDNN,SDANN,RMSSD,PNN50,HRVI of 24hours HRV were negtively correlated with IMT（t=-0.421，-0.381，-0.371，-0.451，-0.397, P＜0.05，Respectively） in nondiabetic MHD patients. (4) Multivariate stepwise regression indicated that HRV parameters ,LDL ,SBP were the independent risk factors for cardiovascular diseases in nondiabetic MHD patients. Conclusion The results indicate that autonomic nerve dysfunction is closely related to atherosclerosis cardiovascular diseases in nondiabetic MHD patients.

Key words: Hemodialysis, Atherosclerosis, Heart rate variability, Carotid initial-medial thickness