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目的探讨持续性心房颤动(PAF)时心率变异性(HRV)评价自主神经功能(AUF)的价值。方法选取符合ACC/AHA(2006)中PAF诊断标准的PAF患者110例,患者在行12导联同步动态心电图检查当日晨6时左右采肘静脉血2管各4ml,采用ELISA法分别检测血清乙酰胆碱酯酶(AChE)和血浆去甲肾上腺素(NE)水平;检测采血前5min的HRV指标和平均心室率,并计算R-R间期标准差(SDNN)、相邻R-R间期差的均方根(rMSSD)、低频(LF)、高频(HF)及LF/HF比值,采用Pearson相关分析法分析SDNN、rMSSD、LF、HF、LF/HF比值和平均心室率与血浆NE和血清AchE水平间的相关性。结果血浆NE水平与SDNN、rMSSD、LF呈负相关(r值分别为-0.236、-0.224、-0.191,P均<0.05),与平均心室率呈正相关(r=0.408,P<0.01),而与HF及LF/HF无显著相关性(P>0.05);血清ACHE水平与SDNN、rMSSD、LF、HF、LF/HF及平均心室率均无显著相关性(P均>0.05)。结论 (1)PAF时HRV分析对AUF无直接评价作用;(2)PAF患者心室率部分受AUF调控。
Objective To investigate the value of heart rate variability (HRV) in assessing autonomic nervous function (AUF) in patients with persistent atrial fibrillation (PAF). Methods A total of 110 patients with PAF who met the criteria of PAF in ACC / AHA (2006) were enrolled in this study. The patients were given 4ml elbow venous blood at 6 o’clock on the 12th day of the same day. ELISA was used to detect serum acetylcholine (AChE) and plasma norepinephrine (NE) were measured. HRV and ventricular rate of 5 min before blood collection were measured. The standard deviation of RR interval (SDNN), mean square root of RR interval difference rMSSD, LF, HF and LF / HF ratios were analyzed. Pearson correlation analysis was used to analyze the association between SDNN, rMSSD, LF, HF, LF / HF and mean ventricular rate with plasma NE and serum AchE levels Correlation. Results Plasma NE levels were negatively correlated with SDNN, rMSSD and LF (r = -0.236, -0.224, -0.191, respectively, P <0.05), and positively correlated with mean ventricular rate (r = 0.408, P <0.01) There was no significant correlation between serum ACHE level and SDNN, rMSSD, LF, HF, LF / HF and mean ventricular rate (P> 0.05). Conclusions (1) The HRV analysis of PAF has no direct evaluation of AUF; (2) The part of ventricular rate of PAF is regulated by AUF.