心率变异性及高敏C反应蛋白与冠状动脉病变程度及预后的相关性研究-东南大学学报医学版

心率变异性及高敏C反应蛋白与冠状动脉病变程度及预后的相关性研究

单位：东南大学附属中大医院心内科, 江苏南京 210009

分类号：O212.1;R541.4

出版年·卷·期（页码）：2014·33·第一期（58-62）

摘要：

目的：探讨心率变异性（HRV）和血浆高敏C反应蛋白（hs-CRP）水平与冠心病患者血管病变程度及预后的相关性。方法：选择行冠状动脉（冠脉）造影的患者306例，根据改良Gensini评分值将患者分为正常组（62例）以及病变轻度组（64例）、中度组（92例）、重度组（88例），术前测定hs-CRP水平并行24 h动态心电图检查，比较不同程度冠脉病变组间hs-CRP及HRV的差异，并随访至少12个月，记录主要不良心脑血管事件（MACCE）发生情况。结果：（1）与正常组比较，病变组hs-CRP水平均明显升高（P<0.05，P<0.01），轻、中、重度3组间比较差异具有统计学意义（P<0.05，P<0.01）；（2）正常R-R间期的标准差（SDNN）和连续5 min窦性心搏R-R间期均值的标准差（SDANN）参数在中、重度组明显降低，与正常组和轻度组比较差异有统计学意义（P<0.05，P<0.01）；相邻正常R-R间期差值的均方根（Rmssd）、24 h内相邻窦性心搏R-R间期差值≥50 ms的心搏数占正常心搏总数的百分比（PNN50）、高频成分（HP）、低频成分（LP）等参数重度组明显低于其它3组（P<0.05，P<0.01）；（3）随访期间冠脉病变组中发生MACCE与无MACCE患者比较，HRV和hs-CRP指标无明显差异。结论：HRV及血清hs-CRP水平与冠脉病变程度相关，对预测和评估冠脉病变严重程度可能具有一定的价值。

Objective: To investigate the relationship between high sensitive C-reactive protein(hs-CRP),heart rate variability(HRV) and severity, prognosis of coronary artery disease(CAD).Methods:306 patients who had accomplished coronary angiography were analyzed and divided into four groups by Gensini scoring, the normal group(n=62),the minimal group(n=64),the moderate group(n=92),the severe group(n=88). Before CAG, all cases underwent 24 hour ambulatory electrocardiogram and serum hs-CRP were detected. Subsequently the clinical information was analyzed and compared. All patients were followed up and the major adverse cardiovascular and cerebral events(MACCE) were recorded for at least 12 months. Results: Compared with the normal group, the serum hs-CRP in the lesion group increased significantly, and showed statistical differences between normal, minimal, moderate and severe group(P<0.05,P<0.01).SDNN and SDANN indices had a decreasing trend with the extent and severity of coronary artery lesion, and showed statistical differences between moderate, severe group and normal, minimal group(P<0.05,P<0.01). RMSSD,PNN50,LP,HP indices decreased significantly in severe group and showed statistical differences between severe group and normal, minimal,moderate group(P<0.05,P<0.01).A total of 17 patients from moderate and severe groups suffered from MACCE during the follow-up. There was no statistical differences between patients with MACCE and those without MACCE(P >0.05).Conclusion:HRV and hs-CRP in serum are closely related to the severity of coronary artery lesions and may have a value in predicting the severity of coronary artery disease.

参考文献：

[1] THAYER J F, YAMAMOTO S S, BROSSCHOT J F.The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors[J].Int J Cardiol, 2010, 141(2):122-131.
[2] KOSUGE M, EBINA T, HIBI K, et, al.Value of serial C-reactive protein measurements in non ST-segment elevation acute coronary syndromes[J].Clinal Cardiol, 2008, 31(9):437-442.
[3] 洪必莹, 何森, 陈晓平.心率变异性研究进展[J].华西医学, 2013, 28(4):614-617.
[4] WAHAB A, ZAHEER M S, RABBANI M U, et, al.A study of heart rate variability and QT dispersion in patients of acute ST elevation myocardial infraction[J].Indian Heart J, 2009, 61(3):261-264.
[5] GANGULY P K, DHALLA K S, SHAO Q, et al.Differential changes in sympathetic activity in left and right ventricles in congestive heart failure after myocardial infarction[J].Am Heart J, 1997, 133: 340.
[6] HAYANA J, SAKA-KIBARA Y, YAMADA M, et al.Decreased magnitude of heart rate spectral components in coronary artery disease, its relation to angiographic severity[J].Circulation, 1993, 88:180-185.
[7] 许宜冠, 周胜华, 沈向前, 等.冠心病患者冠状动脉病变与心率变异性的关系[J].心脏杂志, 2007, 19(5):578-581.
[8] WATANABE M A, SCHMIDT G.Heart rate turbulence:a five year[J].Heart Rhythm, 2004, 1(6):732-738.
[9] TARGHER G.High-sensitivity C-reactive protein, obesity, and subclinical atherosclerosis.Implications of JUPITER from the MESA study[J].Arterioscler Thromb Vasc Biol, 2011, 31(1):1251-1252.
[10] 智宏, 任利群, 刘乃丰, 等.冠心病合并代谢综合征者炎症因子水平与冠脉病变程度的研究[J].东南大学学报:医学版, 2009, 28(1):10-12.
[11] 高阅春, 李全等.超敏C反映蛋白水平与冠心病严重程度及预后的相关性研究[J].中国循环杂志, 2012, 27(3):178-181.
[12] YARON G, BRILL A, DASHEVSKY O, et al.C-reactive protein promotes platelet adhersion to endothelial cells:a potential pathway in atherothrombosis[J].Br J Haematol, 2006, 134(4):426-431.

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