冠心病合并慢性心力衰竭患者心率变异性及心率-压力乘积与疾病程度的关系分析OA
Analysis of the Relationship between Heart Rate Variability,Rate-Pressure Product,and Disease Severity in Patients with Coronary Heart Disease Complicated with Chronic Heart Failure
目的:分析冠心病合并慢性心力衰竭患者的心率变异性(HRV)及心率-压力乘积(RPP)的变化特点及其与疾病程度的关系.方法:回顾性选取 2021 年 5 月—2024 年 8 月于南京鼓楼医院集团宿迁医院确诊并住院治疗的 277 例冠心病患者作为研究对象.根据是否合并慢性心力衰竭,将患者分为合并心衰组(n=185)和冠心病组(n=92).在合并心衰组中,依据 NYHA 心功能分级标准,将患者进一步分为Ⅰ+Ⅱ级、Ⅲ级及Ⅳ级三个亚组.比较各组 HRV、RPP 并分析与疾病严重程度的相关性.结果:合并心衰组患者的 RR 间期平均值标准差(SDANN)、相邻 R-R 间期差值的均方根(RMSSD)、相邻RR 间期差>50 ms 的个数占总心跳次数的百分比(PNN50)、每 5 分钟正常 RR 间期标准差的平均值(SDNN Index)、高频功率(HF)、低频功率(LF)、极低频功率(VLF)均低于冠心病组,RPP 高于冠心病组(P<0.05).多因素 logistic 回 归 分 析 显 示,SDANN[OR=0.985,95%CI(0.974,0.996)]和RMSSD[OR=0.790,95%CI(0.708,0.881)]为冠心病患者合并慢性心力衰竭的保护因素(P<0.05);RPP[OR=1.001,95%CI(1.000,1.001)]为其独立危险因素(P<0.05).采用 Spearman 相关性分析,PNN50、RMSSD 与疾病严重程度呈负相关(rs=-0.837、-0.647,P=0.000),RPP 与疾病严重程度呈正相关(rs=0.666,P=0.000).结论:冠心病合并慢性心力衰竭患者的 HRV 指标降低和 RPP 升高与病情严重程度密切相关,可作为评估疾病进展的有效参考指标.
Objective:To analyze the characteristics of heart rate variability(HRV)and rate-pressure product(RPP)in patients with coronary heart disease complicated with chronic heart failure and their relationship with disease severity.Method:A total of 277 patients with coronary heart disease who were diagnosed and hospitalized at Suqian Hospital,Nanjing Drum Tower Hospital Group between May 2021 and August 2024 were retrospectively enrolled.According to whether chronic heart failure was present,the patients were divided into the combined heart failure group(n=185)and the coronary heart disease group(n=92).In the combined heart failure group,patients were further classified into grade Ⅰ+Ⅱ,grade Ⅲ,and grade Ⅳ subgroups based on NYHA cardiac function grading.HRV and RPP were compared among groups,and their correlations with disease severity were analyzed.Result:Compared with the coronary heart disease group,the standard deviation of the average normal-to-normal intervals(SDANN),the root mean square of successive differences(RMSSD),the percentage of adjacent RR intervals differing by more than 50 ms out of the total number of heartbeats(PNN50),the mean of the standard deviations of all normal-to-normal intervals for all 5-min segments(SDNN Index),high-frequency power(HF),low-frequency power(LF),and very-low-frequency power(VLF)were lower in the combined heart failure group,while the RPP was higher(P<0.05).Multivariate logistic regression analysis shows that,SDANN[OR=0.985,95%CI(0.974,0.996)]and RMSSD[OR=0.790,95%CI(0.708,0.881)]were protective factors for coronary heart disease complicated with chronic heart failure(P<0.05),whereas RPP[OR=1.001,95%CI(1.000,1.001)]was an independent risk factor(P<0.05).Spearman correlation analysis showed that PNN50 and RMSSD were negatively correlated with disease severity(rs=-0.837,-0.647,P=0.000),while the RPP was positively correlated with disease severity(rs=0.666,P=0.000).Conclusion:Reduced HRV and elevated RPP are closely associated with disease severity in patients with coronary heart disease complicated with chronic heart failure,and may serve as effective reference indicators for evaluating disease progression.
沙婷;温冬梅;薛芝
南京鼓楼医院集团宿迁医院心血管内科 江苏 宿迁 223800南京鼓楼医院集团宿迁医院心血管内科 江苏 宿迁 223800南京鼓楼医院集团宿迁医院药学部 江苏 宿迁 223800
冠心病慢性心力衰竭心率变异性心率-压力乘积相关性
Coronary heart diseaseChronic heart failureHeart rate variabilityRate-pressure productCorrelation
《中国医学创新》 2026 (7)
143-147,5
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