Poulikakos Dimitrios, Malik Marek, Banerjee Debasish
Cardiovascular Sciences Research Centre, St. George's University of London, London, UK.
Nephron Clin Pract. 2014;126(3):110-5. doi: 10.1159/000360542. Epub 2014 Mar 29.
Depressed heart rate variability (HRV) reflects abnormal cardiac autonomic regulation and has been linked with increased cardiovascular risk and sudden cardiac death. High parathyroid hormone (PTH) levels have also been associated with an increased risk of sudden cardiac death in haemodialysis (HD) patients. Our aim was to investigate the association between HRV indices and PTH in HD patients.
Continuous intradialytic electrocardiograms were repeated in stable HD patients 5 times every 2 weeks. The absolute values of high-frequency (HF) and low-frequency (LF) HRV components were calculated every 5 min and averaged during the first and last hour of each recording (distinguished by subscripts F and L, respectively). Pre-HD PTH, corrected calcium, and phosphate levels were measured before the first recording.
Data were analysed for 75 subjects aged 60 ± 15, 32% females, 37% diabetics. Baseline biochemical parameters were PTH 44 ± 32 pmol/l, calcium 2.3 ± 0.2 mmol/l, and phosphate 1.6 ± 0.4 mmol/l. All HRV indices showed intra-subject stability over the 5 recordings. Diabetics had lower LFL compared to non-diabetics (-5.5 ± 0.5 vs. -5.2 ± 0.5 after logarithmic transformation, p = 0.012). In non-diabetics, PTH correlated negatively with LFL and HFL (LFL r = -0.340, p = 0.020, HFL r = -0.325, p = 0.026) and phosphate correlated negatively with LFF (r = -0.427, p = 0.003), HFF (r = -0.442, p = 0.002) and HFL (r = -0.307, p = 0.040).
High PTH and phosphate are associated with depressed HRV in non-diabetic dialysis patients. Prospective studies are needed to evaluate the role of mineral abnormalities in autonomic imbalance and arrhythmic risk in HD patients.
心率变异性（HRV）降低反映心脏自主神经调节异常，并与心血管风险增加及心源性猝死相关。高甲状旁腺激素（PTH）水平也与血液透析（HD）患者的心源性猝死风险增加有关。我们的目的是研究HD患者中HRV指标与PTH之间的关联。
对病情稳定的HD患者每2周重复进行5次透析期间的连续心电图检查。每5分钟计算一次高频（HF）和低频（LF）HRV成分的绝对值，并在每次记录的第一小时和最后一小时进行平均（分别用下标F和L区分）。在第一次记录前测量透析前PTH、校正钙和磷水平。
对75名年龄为60±15岁、女性占32%、糖尿病患者占37%的受试者的数据进行了分析。基线生化参数为PTH 44±32 pmol/l、钙2.3±0.2 mmol/l和磷1.6±0.4 mmol/l。所有HRV指标在5次记录中均显示出个体内稳定性。与非糖尿病患者相比，糖尿病患者的LFL较低（对数转换后为-5.5±0.5对-5.2±0.5，p = 0.012）。在非糖尿病患者中，PTH与LFL和HFL呈负相关（LFL r = -0.340，p = 0.020，HFL r = -0.325，p = 0.026），磷与LFF（r = -0.427，p = 0.003）、HFF（r = -0.442，p = 0.002）和HFL（r = -0.307，p = 0.040）呈负相关。
高PTH和高磷与非糖尿病透析患者的HRV降低有关。需要进行前瞻性研究以评估矿物质异常在HD患者自主神经失衡和心律失常风险中的作用。
