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[1]杨玉青,王欣彤,江磊磊,等.急性缺血性脑卒中心率变异性降低相关因素分析[J].医学研究与战创伤救治(原医学研究生学报),2022,24(3):248-252.[doi:10.3969/j.issn.1672-271X.2022.03.005]
　YANG Yu-qing,WANG Xin-tong,JIANG Lei-lei,et al.The related factors of reduced heart rate variability in patients with acute ischemic stroke[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(3):248-252.[doi:10.3969/j.issn.1672-271X.2022.03.005]
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急性缺血性脑卒中心率变异性降低相关因素分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年3期
页码:
248-252
栏目:
临床研究
出版日期:
2022-06-30

文章信息/Info

Title:
The related factors of reduced heart rate variability in patients with acute ischemic stroke
作者:
杨玉青; 王欣彤; 江磊磊; 龚帆影; 杜新芝
作者单位：210029南京，南京中医药大学附属医院功能检查科（杨玉青、江磊磊、龚帆影、杜新芝），脑病中心（王欣彤）
Author(s):
YANG Yu-qing;  WANG Xin-tong;  JIANG Lei-lei;  GONG Fan-ying;  DU Xin-zhi
(1.Department of Functional Examination， 2.Department of Neurology，Affiliated Hospital of Nanjing University of Chinese Medicine，Nanjing 210029，Jiangsu，China)
关键词:
急性缺血性脑卒中; 心率变异性; 心律失常; 2型糖尿病
Keywords:
acute ischemic stroke; heart rate variability; arrhythmia;  type 2 diabetes mellitus
分类号:
R444
DOI:
10.3969/j.issn.1672-271X.2022.03.005
文献标志码:
A
摘要:
目的探讨急性缺血性脑卒中(AIS)心率变异性降低(HRV)的相关因素及HRV降低对心律失常的影响。方法回顾性分析2017年1月-2020年1月南京中医药大学附属医院收治的150例首次AIS患者临床资料，收集并记录动态心电图HRV时域参数，据24 h全部窦性搏动(R-R)间期标准差(SDNN)是否<100ms分为2组；其中71例SDNN<100 ms为观察组，79例SDNN>100 ms为对照组，对比分析HRV降低的相关因素及对心律失常的影响。结果与对照组相比，观察组2型糖尿病(T2DM) [34(47.9) vs 20(25.3), P=0.004]、吸烟[19(26.8) vs 34(43.0), P=0.037]、非持续性室性心动过速(NVST)[4(5.6) vs 0(0), P=0.048]发生率较高，糖化血红蛋白(HbA1c)[6.7(5.9~8.6) vs 6.0(5.6~7.0), P=0.007]水平更高。HRV时域参数SDNN-index[37(29~43) vs 56(49~72), P<0.001]、三角指数[17(14~19) vs 25(23~30), P<0.001]、rMSSD [17(12~28) vs 25(13~47), P=0.007]及pNN50[4(0~14) vs 16(7~35), P<0.001]均较对照组降低。2组间脑梗死面积分级和脑梗死定位差异无统计学意义(P>0.05)。Spearman相关分析显示SDNN(r=-0.215, P=0.008)、SDNN-index(r=-0.199, P=0.015)及三角指数(r=-0.207, P=0.011)与HbA1c呈负相关；SDNN与NVST发生呈负相关(r=-0.164, P=0.045)。结论T2DM与AIS自主神经损伤相关，SDNN降低则NVST发生率增加，因此在治疗AIS原发病的同时，需积极治疗合并症，预防不良心血管事件的发生。
Abstract:
ObjectiveTo identify heart rate variability (HRV) related factors and its impact on arrhythmic risk in acute ischemic stroke (AIS) patients.MethodsTime-domain HRV parameters were retrospectively collected from 150 first-time AIS patients who were admitted to Affiliated Hospital of Nanjing University of Chinese Medicine from January, 2017 to January, 2020. According to the value of SDNN on 24-hour Holter, all patients were assigned into observation group (SDNN<100 ms, n=71) or control group (SDNN>100 ms, n=79). The general clinical data, ischemic stroke localization and size as well as cardiac enzyme and arrhythmias were observed.ResultsCompared with the control group, the patients in the observation group suffered more from type 2 diabetes mellitus (T2DM) [34(47.9) vs 20(25.3), P=0.004] with higher level of glycosylated hemoglobin (HbA1c) [6.7(5.9-8.6) vs 6.0(5.6-7.0), P=0.007] and cigarette smoking [19(26.8) vs 34(43.0), P=0.037], as well as non-sustained ventricular tachycardia (NVST) [4(5.6) vs 0(0), P=0.048]. The time-domain HRV parameters including SDNN-index [37(29-43) vs 56(49-72), P<0.001], triangular index [17(14-19) vs 25(23-30), P<0.001], rMSSD [17(12-28) vs 25(13-47), P=0.007] and pNN50 [4(0-14) vs 16(7-35), P<0.001] were lower in the observation group than that in the control group. Spearman correlation analysis showed that the time-domain HRV parameters including SDNN (r=-0.215, P=0.008), SDNN-index (r=-0.199, P=0.015), and triangular index (r=-0.207, P=0.011) were negatively associated with the level of HbA1c. And SDNN was negatively related with NVST (r=-0.164, P=0.045). There was no significant correlation between time-domain HRV parameters and ischemic stroke localization and size (P>0.05).ConclusionT2DM may worsen autonomic neurological injury following AIS. To preventing adverse cardiovascular events, combination therapies may need for the management of AIS and its comorbidities.

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备注/Memo

备注/Memo:
基金项目：江苏省中医药管理局科技项目（JD2019SZ02）
更新日期/Last Update: 2022-06-21