超高龄持续性心房颤动患者心率变异性与基础临床特征的关系分析

王小艳; 许健; 钱进; 姜苏蓉; 王森

doi:10.7619/jcmp.20234217

超高龄持续性心房颤动患者心率变异性与基础临床特征的关系分析

江苏省人民医院老年心血管科, 江苏南京, 210029

基金项目:

江苏省干部保健科研项目 BJ21019

详细信息

通讯作者:
王森, E-mail: ws20041087@163.com

中图分类号: R541.7;R540.4;R319
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- 文章访问数: 126
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出版历程
- 收稿日期: 2023-12-24
- 修回日期: 2024-02-07
- 网络出版日期: 2024-05-14
- 刊出日期: 2024-05-14

Relationship between heart rate variability and baseline clinical characteristics in super-aged patients with persistent atrial fibrillation

Geriatric Cardiovascular Department, Jiangsu Provincial People's Hospital, Nanjing, Jiangsu, 210029

摘要

摘要:
目的
探讨超高龄(≥ 80岁)持续性心房颤动(简称房颤)患者的心率变异性(HRV)与基础临床特征的关系。
方法
选取108例超高龄持续性房颤患者纳入房颤组, 另选取127例超高龄窦性心律老人纳入对照组, 监测24 h动态心电图, 比较2组心率、HRV时域指标[正常RR间期标准差(SDNN)、全程每5 min RR间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(RMSSD)、全程记录中5 min NN间期标准差平均值(SDNN index)、心率变异指数(HRV index)和相邻NN间期差值>50 ms的心搏数占NN间期总搏数的百分比(PNN50)]。收集房颤患者的基础临床特征, 采用多元线性回归分析探讨HRV时域指标与心率、基础临床特征的相关性。
结果
房颤组的SDNN、RMSSD、HRV index、PNN50、SDNN index均高于对照组, 差异有统计学意义(P < 0.01)。多元线性回归分析结果显示, SDNN升高与高血压(P=0.001)、服用β受体阻滞剂(P=0.003)、心率慢(P < 0.001)显著相关, RMSSD升高与高血压(P=0.040)、服用β受体阻滞剂(P=0.002)、心率慢(P < 0.001)显著相关, HRV index升高与心力衰竭(P=0.003)、心率慢(P < 0.001)显著相关, PNN50升高与心率慢(P=0.004)显著相关; SDNN index升高与服用β受体阻滞剂(P=0.002)、心率慢(P < 0.001)显著相关, SDANN升高与高血压(P=0.006)、心率慢(P < 0.001)、服用达比加群(P=0.021)显著相关。
结论
超高龄持续性房颤患者的HRV与基础临床特征存在相关性, 该现象可能源于自主神经系统的活动状态。
- 超高龄 /
- 房颤 /
- 心率变异性 /
- 高血压 /
- β受体阻滞剂 /
- 达比加群
Abstract:
Objective
To investigate the relationship between heart rate variability (HRV) and baseline clinical characteristics in super-aged (≥ 80 years old) patients with persistent atrial fibrillation (AF).
Methods
A total of 108 super-aged patients with persistent AF were included in AF group, and 127 super-aged patients with sinus rhythm were included in control group. 24-hour ambulatory electrocardiogram monitoring was conducted to compare heart rate and HRV time-domain indicators[standard deviation of normal RR intervals (SDNN), standard deviation of the average of normal to normal intervals (SDANN) every 5 minutes throughout the recording, mean of the sum of the squares of differences between adjacent N-N intervals (RMSSD), average value of standard deviation of 5-minute NN intervals throughout the recording (SDNN index), heart rate variability (HRV) index, and percentage of NN intervals with differences greater than 50 ms accounting for the total number of NN intervals (PNN50)]. Clinical characteristics of AF patients were collected, and multiple linear regression analysis was used to explore the correlation between HRV time-domain indicators and heart rate and baseline clinical characteristics.
Results
SDNN, RMSSD, HRV index, PNN50, and SDNN index were higher in the AF group than in the control group (P < 0.01). Multiple linear regression analysis showed that increased SDNN was significantly associated with hypertension (P=0.001), use of β-blockers (P=0.003), and slow heart rate (P < 0.001). Increased RMSSD wassignificantly associated with hypertension (P=0.040), use of β-blockers (P=0.002), and slow heart rate (P < 0.001). Increased HRV index was significantly associated with heart failure (P=0.003) and slow heart rate (P < 0.001). Increased PNN50 was significantly associated with slow heart rate (P=0.004). Increased SDNN index was significantly associated with the use of β-blockers (P=0.002) and slow heart rate (P < 0.001). Increased SDANN was significantly associated with hypertension (P=0.006), slow heart rate (P < 0.001), and use of dabigatran (P=0.021).
Conclusion
There is a correlation between HRV and baseline clinical characteristics in super-aged patients with persistent AF, which may be due to the activity status of the autonomic nervous system.
- super-age /
- atrial fibrillation /
- heart rate variability /
- hypertension /
- β-blockers /
- dabigatran

HTML全文

表 1 2组心率和HRV时域指标比较(x±s)[M(P₂₅, P₇₅)]

组别	n	心率/min^-1	SDNN/ms	RMSSD/ms	HRV index	PNN50/%	SDNN index/ms	SDANN/ms
房颤组	108	75.3±18.4^**	189.0(145.2, 237.3)^**	233.8(177.3, 280.3)^**	22.8(16.8, 29.8)^**	76.6(68.9, 81.0)^**	164.9(124.6, 205.4)^**	77.4(58.0, 113.7)
对照组	127	67.7±9.5	98.0(76.4, 126.9)	39.9(29.5, 63.7)	13.2(10.1, 16.3)	5.6(3.0, 17.6)	30.8(23.1, 41.0)	87.4(67.4, 109.1)
HRV: 心率变异性; SDNN: 正常RR间期标准差; RMSSD: 相邻NN间期差值的均方根; HRV index: 心率变异指数; PNN50: 相邻NN间期差值>50 ms的心搏数占NN间期总搏数的百分比; SDNN index: 全程记录中5 min NN间期标准差平均值; SDANN: 全程每5 min RR间期平均值的标准差。与对照组比较, * * P < 0.01。

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表 2 SDNN与基础临床特征的多元线性回归分析

自变量	非标准化系数	SE	t	P
年龄	0.385	0.945	0.407	0.685
性别	3.711	9.079	0.409	0.684
高血压	33.391	9.285	3.596	0.001
糖尿病	-0.545	8.695	-0.063	0.950
冠心病	-12.571	8.109	-1.550	0.125
心力衰竭	-12.525	8.459	-1.481	0.142
甲状腺功能异常	0.507	18.358	0.028	0.978
缺血性脑卒中	-2.497	14.080	-0.177	0.860
β受体阻滞剂	24.385	7.962	3.063	0.003
非二氢吡啶类钙离子拮抗剂	-0.637	16.343	-0.039	0.969
地高辛	9.246	9.391	0.985	0.327
华法林	1.132	11.580	0.098	0.922
达比加群	27.925	10.879	2.567	0.012
利伐沙班	0.997	11.032	0.090	0.928
心率	-2.027	0.217	-9.337	< 0.001

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表 3 RMSSD与基础临床特征的多元线性回归分析

自变量	非标准化系数	SE	t	P
年龄	0.683	1.460	0.468	0.641
性别	6.620	14.032	0.472	0.638
高血压	29.868	14.351	2.081	0.040
糖尿病	-4.764	13.439	-0.354	0.724
冠心病	-7.124	12.534	-0.568	0.571
心力衰竭	-12.055	13.075	-0.922	0.359
甲状腺功能异常	-5.215	28.375	-0.184	0.855
缺血性脑卒中	2.090	21.762	0.096	0.924
β受体阻滞剂	39.973	12.306	3.248	0.002
非二氢吡啶类钙离子拮抗剂	2.712	25.260	0.107	0.915
地高辛	7.913	14.515	0.545	0.587
华法林	3.047	17.899	0.170	0.865
达比加群	8.227	16.815	0.489	0.626
利伐沙班	10.107	17.052	0.593	0.555
心率	-1.631	0.336	-4.862	< 0.001

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表 4 HRV index与基础临床特征的多元线性回归分析

自变量	非标准化系数	SE	t	P
年龄	0.026	0.178	0.148	0.883
性别	0.482	1.714	0.281	0.779
高血压	-0.660	1.753	-0.376	0.707
糖尿病	-1.241	1.641	-0.756	0.452
冠心病	0.561	1.531	0.367	0.715
心力衰竭	-4.838	1.597	-3.030	0.003
甲状腺功能异常	3.019	3.465	0.871	0.386
缺血性脑卒中	5.125	2.658	1.928	0.057
β受体阻滞剂	1.415	1.503	0.942	0.349
非二氢吡啶类钙离子拮抗剂	5.145	3.085	1.668	0.099
地高辛	1.937	1.773	1.093	0.277
华法林	2.033	2.186	0.930	0.355
达比加群	-1.485	2.054	-0.723	0.471
利伐沙班	0.649	2.083	0.312	0.756
心率	-0.307	0.041	-7.503	< 0.001

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表 5 PNN50与基础临床特征的多元线性回归分析

自变量	非标准化系数	SE	t	P
年龄	0.161	0.293	0.551	0.583
性别	3.034	2.813	1.079	0.284
高血压	-2.247	2.877	-0.781	0.437
糖尿病	-0.576	2.694	-0.214	0.831
冠心病	1.868	2.512	0.743	0.459
心力衰竭	-1.237	2.621	-0.472	0.638
甲状腺功能异常	3.933	5.687	0.692	0.491
缺血性脑卒中	2.215	4.362	0.508	0.613
β受体阻滞剂	3.440	2.467	1.395	0.166
非二氢吡啶类钙离子拮抗剂	3.792	5.063	0.749	0.456
地高辛	0.506	2.909	0.174	0.862
华法林	4.304	3.588	1.200	0.233
达比加群	-2.462	3.370	-0.730	0.467
利伐沙班	4.895	3.418	1.432	0.155
心率	-0.198	0.067	-2.938	0.004

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表 6 SDNN index与基础临床特征的多元线性回归分析

自变量	非标准化系数	SE	t	P
年龄	0.311	1.038	0.299	0.765
性别	3.736	9.975	0.374	0.709
高血压	18.350	10.201	1.799	0.075
糖尿病	-3.667	9.553	-0.384	0.702
冠心病	-3.499	8.910	-0.393	0.695
心力衰竭	-7.105	9.294	-0.764	0.447
甲状腺功能异常	-1.577	20.170	0.078	0.938
缺血性脑卒中	0.705	15.469	0.046	0.964
β受体阻滞剂	27.533	8.748	3.147	0.002
非二氢吡啶类钙离子拮抗剂	9.256	17.956	0.515	0.607
地高辛	4.734	10.318	0.459	0.647
华法林	8.135	12.723	0.639	0.524
达比加群	9.167	11.953	0.767	0.445
利伐沙班	14.680	12.121	1.211	0.229
心率	-1.324	0.239	-5.552	< 0.001

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表 7 SDANN与基础临床特征的多元线性回归分析

自变量	非标准化系数	SE	t	P
年龄	0.433	0.913	0.474	0.637
性别	2.442	8.771	0.278	0.781
高血压	25.155	8.970	2.804	0.006
糖尿病	-0.455	8.400	-0.054	0.957
冠心病	-10.919	7.834	-1.394	0.167
心力衰竭	-15.479	8.172	-1.894	0.061
甲状腺功能异常	1.386	17.735	0.078	0.938
缺血性脑卒中	1.263	13.602	0.093	0.926
β受体阻滞剂	2.430	7.692	0.316	0.753
非二氢吡啶类钙离子拮抗剂	-2.403	15.788	-0.152	0.879
地高辛	5.745	9.072	0.633	0.528
华法林	-3.418	11.188	-0.305	0.761
达比加群	24.656	10.510	2.346	0.021
利伐沙班	-17.219	10.658	-1.616	0.110
心率	-1.427	0.210	-6.804	< 0.001

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