心肌缺血总负荷值、心率变异性及校正Q-T离散度与冠状动脉病变程度的相关性
Correlation of severe coronary artery lesion with total ischemic burden value，heart rate variability and corrected QT interval dispersion
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摘要: 目的：分析不同临床类型冠心病患者的心肌缺血总负荷值(TIB)、心率变异性(HRV)及校正Q-T离散度(QTcd)的变化,并探讨它们与冠状动脉病变程度的相关性。方法：选择行冠状动脉造影者131例,根据造影结果及临床病史,分为稳定型心绞痛组(SAP组)31例、不稳定型心绞痛组(UAP组)35例、急性心肌梗死组(AMI组)35例和冠状动脉造影无异常组(对照组)30名。每组均行24 h动态心电图检查,得出TIB、HRV指标(PNN50、SDNN、SDANN、RMSSD)及校正QTcd,进行对比分析;采用Gensini积分评定冠状动脉病变程度,分析冠心病患者HRV指标与TIB、QTcd与Gensini积分的相关性;比较所有研究对象不同范围QTcd的室性心动过速发生率。结果:SAP组、UAP组和AMI组的HRV指标均较对照组降低(P0.05~P0.01);UAP组的HRV指标均较SAP组显著降低(P0.01);AMI组的HRV指标较UAP组显著降低(P0.01);UAP组和AMI组的TIB均较对照组和SAP组显著升高(P0.01);AMI组的TIB较UAP组显著升高(P0.01)。SAP组、UAP组和AMI组的QTcd均较对照组显著升高(P0.01);UAP组和AMI组的QTcd均较SAP组显著升高(P0.01);AMI组的QTcd值较UAP组显著升高(P0.01)。UAP组和AMI组的Gensini积分均较SAP组显著升高(P0.01);AMI组的Gensini积分较UAP组显著升高(P0.01)。HRV指标与Gensini积分均呈负相关关系(P0.05);而TIB和QTcd与Gensini积分均呈正相关关系(P0.05)。QT60 ms者室性心动过速发生率最高(0.05)。结论：不同临床类型冠心病TIB、HRV指标、QTcd和Gensini积分有明显差异性;冠状动脉病变程度越严重,TIB、QTcd越大,而HRV越小;QTcd越大,室性心动过速发生率越高。TIB、HRV、QTcd对判断冠心病患者的病情和预后有一定作用。Abstract: Objective: To measure the Objective: Total ischemic burden(TIB),heart rate variability(HRV) and corrected QT interval dispersion (QTcd) in patients with different clinical types of coronary heart disease， and investigate their correlation with the severity of coronary artery lesion. Methods: Objective: Total 131 patients undergoing coronary angiography were included. According Objective: To the results of coronary angiography and clinical hisObjective: Tory， the patients were divided inObjective: To stable angina pecObjective: Toris group (SAP group，n = 31),unstable angina Objective: Toris group(UAP group，n = 35) and acute myocardial infarction group(AMI group，n = 35) ; and 30 persons without coronary artery lesion by coronary angiography were included as control group(n = 30). TIB，HRV index(PNN50，SDNN，SDANN，RMSSD) and QTcd were assessed by 24-hour dynamic electrocardiogram in all groups. Gensini score was also calculated as a measure of the severity of coronary artery lesion， and the correlation between HRV index，TIB，QTcd Gensini score was evaluated. The incidence of ventricular tachycardia in different range of QTcd was compared among all groups. Results: HRV index in SAP group，UAP group and AMI group were lower than those in control group(P ＜ 0. 05 Objective: To P ＜ 0. 01). HRV index in UAP group were significantly lower than those in SAP group(P ＜ 0. 01). HRV index in AMI group were significantly lower than those in UAP group(P ＜ 0. 01). TIB in UAP group and AMI group was significantly higher than that in control group and SAP group(P ＜ 0. 01). TIB in AMI group was significantly higher than that in UAP group(P ＜ 0. 01). QTcd in SAP group，UAP group and AMI group was significantly higher than that in control group(P ＜0. 01). QTcd in UAP group and AMI group was significantly higher than that in SAP group(P ＜ 0. 01). QTcd in AMI group was significantly higher than that in UAP group(P ＜ 0. 01). Gensini score in UAP group and AMI group was significantly higher than that in SAP group (P ＜ 0. 01 ). Gensini score in AMI group was significantly higher than that in UAP group(P ＜ 0. 01). HRV index were all negatively correlated with Gensini score(P ＜0. 05). TIB and QTcd were positively orrelated with Gensini score (P ＜ 0. 05 ). The highest incidence of ventriculartachycardia was occurred when QTcd was more than 60 ms(P ＜ 0. 05). Conclusions: TIB，HRV index，QTcd and Gensini score were varied with the clinical type of coronary heart disease. The more serious coronary artery lesions were， the higher values of TIB and QTcd were， the lower values of HRV index were. The increased QTcd commonly led Objective: To a higher incidence of ventricular tachycardia. It should be paid more attentions about TIB，HRV and QTcd on assessing the severity and prognosis of patients with coronary heart disease.
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