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目的探讨急性冠脉综合征(ACS)患者心率震荡(HRT)的变化及对患者预后的评价。方法选择2008年10月至2009年9月在天津市胸科医院住院的170例确诊为ACS患者(ACS组),同期50例正常者为对照组。所有入选者均在入院后行24 h动态心电图检查,分析和测量HRT的参数:震荡初始(TO)和震荡斜率(TS),并同时记录临床信息、左室射血分数(LVEF)。同时对ACS患者平均随访(20.5±12.2)个月,根据随访中是否发生心血管不良事件(MACE)将ACS患者分为MACE事件组和非MACE事件组。结果与对照组比较ACS组的TO显著增高(P<0.01),而TS则显著降低(P<0.01);MACE事件组与非MACE事件组比较TO显著增高(P<0.01),TS显著降低(P<0.01);Logistic回归分析显示TO、TS、LVEF对患者预后的预测作用最好。Pearson相关分析显示LVEF与TO呈负相关(r=-0.165,P=0.016),与TS呈正相关(r=0.172,P=0.012);HDL-C与TO呈负相关(r=-0.171,P=0.012),与TS呈正相关(r=0.235,P=0.001)。结论ACS患者的HRT明显减弱,迷走神经调节功能下降;HRT在评价患者预后中具有良好的临床参考价值。HRT与HDL-C的相关性不仅表明HRT能够反映HDL-C的水平,同时进一步证实HRT在评价患者预后中的价值。
Objective To investigate the changes of heart rate turbulence (HRT) in patients with acute coronary syndrome (ACS) and to evaluate the prognosis of patients. Methods 170 patients diagnosed as ACS (ACS group) hospitalized in Tianjin Thoracic Hospital from October 2008 to September 2009 were selected, and 50 normal subjects were selected as the control group. All participants were enrolled 24 hours after admission, Holter examination, analysis and measurement of HRT parameters: shock initial (TO) and shock slope (TS), and meanwhile clinical information, left ventricular ejection fraction (LVEF) was recorded. Patients with ACS were followed up for an average of (20.5 ± 12.2) months. ACS patients were divided into MACE group and non-MACE group according to MACE. Results Compared with the control group, TO in ACS group was significantly increased (P <0.01) and TS was significantly decreased (P <0.01); TOE in MACE group was significantly higher than that in non-MACE group (P <0.01) P <0.01). Logistic regression analysis showed that TO, TS, LVEF had the best prognosis in patients. Pearson correlation analysis showed that LVEF was negatively correlated with TO (r = -0.165, P = 0.016) and positively correlated with TS (r = 0.172, P = 0.012) = 0.012) and positively correlated with TS (r = 0.235, P = 0.001). Conclusion The HRT of ACS patients is significantly weakened and the vagal modulation function is decreased. HRT has a good clinical reference value in evaluating the prognosis of patients. The correlation between HRT and HDL-C not only shows that HRT can reflect the level of HDL-C, but also further confirm the value of HRT in evaluating the prognosis of patients.