Kida Nanami, Tsubakihara Yoshiharu, Kida Hirota, Ageta Shunro, Arai Makoto, Hamada Yoshinosuke, Matsuura Nariaki
Department of Molecular Pathology, Osaka University Graduate School of Medicine and Health Science, 1-1 yamadaoka, 565-0871, Suita City, Osaka, Japan.
Department of Blood Purification Center, Nagahara Hospital, 4-3-13 nagatanishi, 577-0016, Higashiosaka City, Osaka, Japan.
BMC Nephrol. 2017 Jan 5;18(1):8. doi: 10.1186/s12882-016-0423-3.
Major adverse cardiac and cerebrovascular event (MACCE) is one of most common complications of hemodialysis patients. Heart rate variability (HRV) is the predictor of death in heart disease patients. However, there are no studies on the role of HRV in hemodialysis patients.
From September 2009 to March 2011, 24-h electrocardiography was performed in 101 hemodialysis patients. Standard deviation of sequential 5-minute N-N interval means (SDANN) and standard deviation of the N-N interval (SDNN) was examined by a 24-h ECG analysis. Patients were observed prospectively. The primary endpoints were incidence of MACCE and MACCE-free survival.
We studied 90 hemodialysis patients (64 males, 63.4 ± 11.8 years old). During a follow-up period of 32.0 ± 11.7 months, 33 patients developed MACCE. 24-h ECG showed mean SDNN 93.4 ± 33.4 ms and mean SDANN 83.2 ± 31.3 ms. MACCE group showed significantly lower SDNN and SDANN than event-free group. In Kaplan-Meier analysis higher SDNN and SDANN group showed significantly higher event-free survival rate than lower group. Using a Cox proportional hazards model, SDNN was independent prognostic factor while SDANN or diabetic status was not significant. In diabetic cases, there were no differences in any factors for the incidence of MACCE between higher SDNN, SDANN groups and lower groups. On the other hand in non-diabetic cases, lower SDNN or SDANN group developed significantly higher MACCE than higher groups.
Measurement of HRV by Holter ECG is useful to predict MACCE in hemodialysis patients, especially non-diabetic group.
重大心脑血管事件（MACCE）是血液透析患者最常见的并发症之一。心率变异性（HRV）是心脏病患者死亡的预测指标。然而，尚无关于HRV在血液透析患者中作用的研究。
2009年9月至2011年3月，对101例血液透析患者进行24小时心电图检查。通过24小时心电图分析检测连续5分钟N-N间期均值的标准差（SDANN）和N-N间期的标准差（SDNN）。对患者进行前瞻性观察。主要终点是MACCE的发生率和无MACCE生存期。
我们研究了90例血液透析患者（64例男性，年龄63.4±11.8岁）。在32.0±11.7个月的随访期内，33例患者发生了MACCE。24小时心电图显示平均SDNN为93.4±33.4毫秒，平均SDANN为83.2±31.3毫秒。MACCE组的SDNN和SDANN显著低于无事件组。在Kaplan-Meier分析中，SDNN和SDANN较高的组的无事件生存率显著高于较低的组。使用Cox比例风险模型，SDNN是独立的预后因素，而SDANN或糖尿病状态不显著。在糖尿病病例中，SDNN、SDANN较高组和较低组之间MACCE发生率的任何因素均无差异。另一方面，在非糖尿病病例中，SDNN或SDANN较低组的MACCE发生率显著高于较高组。
通过动态心电图测量HRV有助于预测血液透析患者，尤其是非糖尿病组的MACCE。
