Guo Xiao-Yu, Li Fang-Jie
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2017 Mar;37(3):297-301.
Objective To analyze the chaotic degree of excess/deficiency syndrome (ES/DS) in chronic stable angina pectoris (CSAP) patients by observing 24-h dynamic changes of approximate en- tropy index of heart rate variability per hour, and to observe dynamic changing features. Methods From November 2009 to June 2011, a total of 187 CSAP patients were assigned to ES (36 cases) , DS (42 ca- ses) , intermingled syndrome of deficiency and excess (109 cases, abbreviated as intermingled ES/DS) according to TCM syndrome differentiation standards.24 h dynamic electrocardiograms were collected u- sing USA DMS dynamic ECG, which was then divided into 24 continuous period by hour. The approximate entropy algorithm (by hour) was respectively calculated. The approximate entropy diurnal variation trend was analyzed in patients with different TCM syndromes. These results were controlled with 30 healthy subjects who had normal physical examinations at the same hospital. Results The approximate entropy mean value of each hour throughout the day was lower, as compared with the healthy group (F=7. 847, P <0. 01). Although no statistical difference existed among ES, DS, intermingled ES/DS (F =1. 585, P = 0. 208), the approximate entropy mean value showed the tendency of ES >intermingled ES/DS > ES. From 8:00 a.m. to 7:00 a.m. on the next day, the variation tendency of four-group curves all showed that the approximate entropy level changed as time went by (F =2. 655, P <0. 01). Besides, the approximate en- tropy diurnal variation of ES, DS, intermingled ES/DS showed a similar trend (F =1. 011 ,P =0. 457) , but different from the healthy group (F = 1. 583, P = 0. 003). The curve in the healthy group showed "two peaks and one valley" type [one peak from 10:00 to 14:00, and the other peak from 22:00 to 02:00]. The curve for ES, DS, intermingled ES/DS showed an inverted dipper type [only a peak at night, and a relatively stable curve from 8:00 to 19:00]. Compared with the normal group, the day peak disappeared in CSAP patients, and the daytime approximate entropy was significantly reduced (F = 10. 315, P <0. 01). Conclusions Compared with the healthy group, the approximate entropy of CSAP patients decreased, which means the chaotic degree reduced. The adaptability of the cardiovascular system to external envi- ronment changes was weakened, which was more obviously seen at daytime than at night. The chaotic degree showed gradually decreasing trend (ES > DS >intermingled DS/ES).
目的 通过观察慢性稳定型心绞痛（CSAP）患者心率变异性近似熵指数每小时的24小时动态变化，分析其虚实辨证（ES/DS）的紊乱程度，并观察动态变化特征。方法 2009年11月至2011年6月，根据中医辨证标准，将187例CSAP患者分为实证组（36例）、虚证组（42例）、虚实夹杂证组（109例，简称为虚实夹杂ES/DS）。采用美国DMS动态心电图收集24小时动态心电图，然后按小时分为24个连续时段。分别计算近似熵算法（按小时）。分析不同中医证型患者的近似熵日变化趋势。这些结果与在同一家医院进行正常体检的30名健康受试者进行对照。结果 与健康组相比，全天各小时的近似熵平均值较低（F=7.847，P<0.01）。虽然实证组、虚证组、虚实夹杂ES/DS组之间无统计学差异（F=1.585，P=0.208），但近似熵平均值呈实证组>虚实夹杂ES/DS组>虚证组的趋势。从上午8:00至次日上午7:00，四组曲线的变化趋势均显示近似熵水平随时间变化（F=2.655，P<0.01）。此外，实证组、虚证组、虚实夹杂ES/DS组的近似熵日变化趋势相似（F=1.011，P=0.457），但与健康组不同（F=1.583，P=0.003）。健康组曲线呈“双峰一谷”型[一个峰在10:00至14:00，另一个峰在22:00至02:00]。实证组、虚证组、虚实夹杂ES/DS组曲线呈反勺型[仅夜间有一个峰，8:00至19:00曲线相对稳定]。与正常组相比，CSAP患者的日峰消失，白天近似熵显著降低（F=10.315，P<0.01）。结论 与健康组相比，CSAP患者的近似熵降低，即紊乱程度降低。心血管系统对外部环境变化的适应性减弱，白天比夜间更明显。紊乱程度呈逐渐降低趋势（实证组>虚证组>虚实夹杂DS/ES组）。
