腹膜透析患者血压与心率变异性关系的横断面研究

Li Li-xian, Tang Wen, Chen Bo-jun, Wang Tao

Department of Nephrology, Peking University Third Hospital, Beijing 100191, China.

Beijing Da Xue Xue Bao Yi Xue Ban. 2011 Dec 18;43(6):849-54.

OBJECTIVE

To analyze the possible relationship between heart rate variability (HRV) and blood pressure in peritoneal dialysis patients.

METHODS

In this cross-sectional study, 93 continuous ambulatory peritoneal dialysis patients (CAPD) patients were enrolled. Patients were divided into three groups according blood pressure. HRV which reflects autonomic nerve function (ANF) were measured by using 5-minutes recordings of a stationary system by a standardized method. Both time-domain and frequency domain parameters were analyzed.

RESULTS

HRV time domain indices [the standard deviation of all normal RR intervals (SDNN), the square root of the mean of the squared differences between adjacent normal RR intervals (rMSSD), the standard deviation of differences between adjacent NN intervals (SDSD), the percentage of differences between adjacent normal RR intervals that were >50 ms computed (PNN50)] and frequency domain indices [the low-frequency energy in the power spectrum 0.04-0.15 Hz (LF), the high-frequency energy in the power spectrum 0.15-0.4 Hz (HF)] were significantly lowest in hypertensive group (P<0.05) whereas LF/HF was highest as compared to normal BP group (P<0.05). Univariable correlation analysis showed that both systolic and diastolic blood pressure were negatively correlated with SDNN (r=-0.386, P<0.001; r=-0.399, P<0.001), rMSSD (r=-0.373, P<0.001; r=-0.426, P<0.001), SDSD (r=-0.375, P<0.001; r=-0.425, P<0.001), PNN50 (r=-0.223, P=0.032; r=-0.245, P=0.018), TP (r=-0.328, P=0.001; r=- 0.312, P=0.002), LF (r=-0.260, P= 0.012; r=-0.194, P=0.063), HF (r=-0.394, P<0.001; r=-0.365, P<0.001), and positively correlated with LF/HF (r=0.275, P=0.008; r=0.171, P=0.1). Multivariable regression analysis showed that HRV indicators were independently factor affecting both systolic and diastolic blood pressure in PD patients.

CONCLUSION

ANF assessed by HRV were significantly different in PD patients with blood status, parasympathetic nerve were activated in hypotension group whereas sympathetic nerve were activated in hypertension group. ANF was independently factors associated with blood pressure.

目的

分析腹膜透析患者心率变异性（HRV）与血压之间的可能关系。

方法

在这项横断面研究中，纳入了93例持续性非卧床腹膜透析（CAPD）患者。根据血压将患者分为三组。采用标准化方法，通过固定系统记录5分钟的心电信号来测量反映自主神经功能（ANF）的HRV。对时域和频域参数均进行了分析。

结果

HRV时域指标[所有正常RR间期的标准差（SDNN）、相邻正常RR间期平方差均值的平方根（rMSSD）、相邻NN间期差值的标准差（SDSD）、计算得出的相邻正常RR间期差值>50 ms的百分比（PNN50）]和频域指标[功率谱中0.04 - 0.15 Hz的低频能量（LF）、功率谱中0.15 - 0.4 Hz的高频能量（HF）]在高血压组中显著最低（P<0.05），而与正常血压组相比，LF/HF最高（P<0.05）。单变量相关性分析显示，收缩压和舒张压均与SDNN呈负相关（r = -0.386，P<0.001；r = -0.399，P<0.001）、rMSSD（r = -0.373，P<0.001；r = -0.426，P<0.001）、SDSD（r = -0.375，P<0.001；r = -0.425，P<0.001）、PNN50（r = -0.223，P = 0.032；r = -0.245，P = 0.018）、TP（r = -0.328，P = 0.001；r = -0.312，P = 0.002）、LF（r = -0.260，P = 0.012；r = -0.194，P = 0.063）、HF（r = -0.394，P<0.001；r = -0.365，P<0.001），并与LF/HF呈正相关（r = 0.275，P = 0.008；r = 0.171，P = 0.1）。多变量回归分析显示，HRV指标是影响腹膜透析患者收缩压和舒张压的独立因素。