Coquet Isaline, Mousson Christiane, Rifle Gerard, Laurent Gabriel, Moreau Daniel, Cottin Yves, Zeller Marianne, Touzery Claude, Wolf Jean Eric
Departement de néphrologie, Center Hospitalier Universitaire, Dijon Cedex, France.
Ren Fail. 2005;27(1):7-12.
Sudden cardiac death occurring in patients with end-stage renal disease (ESRD) may be related to poor autonomic function with a significant decreased heart-rate variability (HRV). In addition, coronary artery disease has a high prevalence in this population and accounts for 50% of deaths. In the present study, relationships between HRV and myocardial ischemic abnormalities revealed by myocardial scintigraphy (MS) were evaluated in 32 chronic hemodialysis patients.
We prospectively studied 32 chronic hemodialysis patients. Each underwent MS and 24 h electrocardiography at baseline for analysis of time and frequency domain the day of dialysis. Three periods were analyzed: during dialysis session, the morning after (nondialytic period), and in a 24 h period. Patients were included in group 1 (seven women, 11 men; mean age: 62+/-19 years) when MS revealed no ischemia, whereas patients were included in group 2 (seven women, seven men; mean age: 63.1+/-20 years) when MS revealed ischemic lesions.
A student+/-test revealed that during the nondialytic period, two important markers of HRV, percentage of delta RR>50 ms (pNN50) (4.5+/-4.04 in group 1 versus 1.7+/-1.4 in group 2), and root mean square of delta RR (rMSSD) (27.7+/-13.4 versus 19.7+/-6.8) were significantly reduced in group 2 compared with values in group 1. No significant difference appears between the two groups for standard deviation of normal to normal intervals (SDNN), mean heart rate, and spectral analysis.
Patients with ESRD and myocardial ischemia revealed by MS have reduced parasympathetic activity during the nondialytic period. Correlations between parameters of HRV and ischemic lesions revealed by MS have been shown for the first time.
终末期肾病（ESRD）患者发生的心源性猝死可能与自主神经功能不良及心率变异性（HRV）显著降低有关。此外，冠状动脉疾病在该人群中患病率较高，占死亡人数的50%。在本研究中，对32例慢性血液透析患者的HRV与心肌闪烁显像（MS）显示的心肌缺血异常之间的关系进行了评估。
我们对32例慢性血液透析患者进行了前瞻性研究。每位患者在基线时均接受了MS检查和24小时心电图检查，以便在透析当天分析时域和频域。分析了三个时间段：透析期间、透析后次日上午（非透析期）以及24小时时间段。当MS显示无缺血时，患者被纳入第1组（7名女性，11名男性；平均年龄：62±19岁），而当MS显示有缺血性病变时，患者被纳入第2组（7名女性，7名男性；平均年龄：63.1±20岁）。
学生t检验显示，在非透析期，HRV的两个重要指标，RR间期变化大于50毫秒的百分比（pNN50）（第1组为4.5±4.04，第2组为1.7±1.4）以及RR间期变化的均方根（rMSSD）（27.7±13.4对19.7±6.8），第2组与第1组相比显著降低。两组在正常到正常间期的标准差（SDNN）、平均心率和频谱分析方面无显著差异。
MS显示有心肌缺血的ESRD患者在非透析期副交感神经活动降低。首次显示了HRV参数与MS显示的缺血性病变之间的相关性。
