慢性肾脏病患者心率变异性相关影响因素及预防对策

余福海; 沈才杰; 陆曹杰; 赵馥; 王健; 张丹

doi:10.16766/j.cnki.issn.1674-4152.001920

慢性肾脏病患者心率变异性相关影响因素及预防对策

doi: 10.16766/j.cnki.issn.1674-4152.001920

余福海¹,
沈才杰^2, ,,
陆曹杰¹,
赵馥¹,
王健²,
张丹¹

1.
宁波市奉化区人民医院肾内科，浙江宁波 315500
2.
宁波市第一医院心内科，浙江宁波 315000

基金项目:

浙江省医药卫生科研项目 2019KY642

详细信息

通讯作者:
沈才杰, E-mail: shenzihai1101@126.com

中图分类号: R692 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2020-06-02
- 网络出版日期: 2022-02-16

Related influencing factors and preventive measures of heart rate variability in patients uffer from chronic kidney disease

1.
Department of Nephrology, People's Hospital of Fenghua District, Ningbo, Zhejiang 315500, China

摘要

摘要: 目的分析慢性肾脏病(chronic kidney disease，CKD)患者心率变异性(heart rate variability，HRV)的变化情况及影响因素，以期进行针对性干预。方法选取2017年3月—2019年3月期间收治宁波市第一医院及奉化区人民医院的CKD患者138例作为研究对象，采用MARS动态心电分析软件和Seer Light心电盒进行24 h动态心电图监测患者HRV时域分析参数[RR间期平均值标准差(SDANN)、24 h正常R-R间期标准差(SDNN)、24 h内相邻窦性R-R间期差值＞50 m个数所占百分比(pNN50)、相应正常R-R间期超值均方的平方根(rMSSD)]变化，并采用多元线性逐步回归分析其各自的影响因素。结果多元线性逐步回归结果显示，白介素6(IL-6)是SDANN的影响因素(t=2.243, P=0.029)，血红蛋白(Hb)、C反应蛋白(CRP)、IL-6、臂踝脉搏波传导速度(baPWV)是SDNN的影响因素(t=2.084、3.515、4.594、5.523，均P < 0.05)，血磷、baPWV是pNN50的影响因素(t=2.021、2.536，均P < 0.05)，Hb、IL-6、血钾是rMSSD的影响因素(t=2.156、4.417、2.642，均P < 0.05)。结论 CKD患者伴随HRV时域分析参数下降，且与贫血、微炎症状态、电解质紊乱、动脉硬化有关，临床可针对上述危险因素进行干预。
- 慢性肾脏病 /
- 心率变异性 /
- 影响因素
Abstract: Objective To analyse changes and influencing factors of heart rate variability (HRV) in patients with chronic kidney disease (CKD) for conducting targeted intervention. Methods A total of 138 CKD patients who were admitted to the First Hospital of Ningbo from March 2017 and March 2019 were enrolled as study objects. MARS Holter analysis software and Seer Light ECG box were used to monitor patient' HRV time-domain analysis parameters for 24 h [standard deviation of 5-minute average NN intervals (SDANN), standard deviation of NN intervals (SDNN), the percentage of NN50 in the total number of normal-to-normal intervals (pNN50), square root of the mean of the squared differences between adjacent normal RR (rMSSD)] were detected. The multivariate linear stepwise regression analysis was applied to analyse their influencing factors. Results The results of multiple linear stepwise regression showed that interleukin 6 (IL-6) was an influencing factor of SDANN (t=2.243, P=0.029). Haemoglobin (Hb), C-reactive protein (CRP), IL-6, brachial and ankle pulse wave velocity (baPWV) were influencing factors of SDNN (t=2.084, 3.515, 4.594, 5.523, all P < 0.05). Blood phosphorus and baPWV were the influencing factors of pNN50 (t=2.021, 2.536, all P < 0.05). Hb, IL-6 and serum potassium were the influencing factors of Root Mean Square of the Successive Differences (rMSSD, t=2.156, 4.417, 2.642, all P < 0.05). Conclusion CKD patients are accompanied with decrease of HRV time-domain analysis parameters, which is related to anaemia, micro-inflammation status, electrolyte imbalance and arteriosclerosis. Clinically, intervention can be conducted aiming at the above risk factors.
- Chronic kidney disease /
- Heart rate variability /
- Influencing factor

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表 1 CKD 1~5期患者基线资料比较(例)

分期	例数	性别		年龄 (x±s，岁)	原发病类型
分期	例数	男性	女性	年龄 (x±s，岁)	慢性肾炎	糖尿病肾病	高血压肾病	其他
CKD 1期	32	18	14	61.01±5.29	11	5	15	1
CKD 2期	39	21	18	62.75±5.64	17	11	9	2
CKD 3期	42	23	19	61.97±5.38	16	13	8	5
CKD 4~5期	25	15	10	63.26±5.17	11	8	4	2
统计量		0.260^a		0.916^b	12.038^a
P值		0.967		0.435	0.211
注：^a为χ²值，^b为F值。

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表 2 CKD 1~5期患者实验室指标比较(x±s)

分期	例数	Scr(μmol/L)	Hb(g/L)	CRP(mg/L)	IL-6(pg/L)	HbA1c(%)	TC(mmol/L)	TG(mmol/L)
CKD 1期	32	76.33±9.24	142.16±15.31	2.94±0.68	4.11±1.05	7.94±1.36	4.89±1.02	1.65±0.75
CKD 2期	39	126.37±12.05^a	134.05±14.69^a	4.05±1.02^a	6.27±1.53^a	7.76±1.28	4.76±1.11	1.69±0.77
CKD 3期	42	219.57±25.22^ab	120.34±14.11^ab	6.87±1.19^ab	10.92±1.79^ab	7.84±1.13	5.08±1.26	1.78±0.76
CKD 4~5期	25	426.21±52.34^abc	94.13±13.94^abc	13.19±1.58^abc	22.05±2.94^abc	8.58±1.09	5.11±1.32	1.72±0.68
F值		891.331	71.037	457.249	541.220	2.620	0.693	0.202
P值		< 0.001	< 0.001	< 0.001	< 0.001	0.053	0.560	0.895

分期	例数	血钾(mmol/L)	血钠(mmol/L)	血钙(mmol/L)	血磷(mmol/L)	CO₂CP(mmol/L)	baPWV(cm/s)
CKD 1期	32	4.03±0.69	145.62±12.97	2.41±0.97	1.39±0.65	29.18±3.97	1359.42±119.64
CKD 2期	39	3.96±0.71	144.78±11.34	2.32±0.86	1.34±0.71	28.76±3.05	1594.15±125.06^a
CKD 3期	42	4.28±0.57	143.05±12.48	2.35±0.81	1.45±0.69	27.18±2.70	1722.05±128.80^ab
CKD 4~5期	25	4.72±0.76^abc	141.64±10.38	2.28±0.84	2.03±0.75^abc	24.14±2.21^abc	1826.34±132.51^abc
F值		7.589	0.662	0.117	5.816	22.771	77.256
P值		< 0.001	0.577	0.950	< 0.001	< 0.001	< 0.001
注：与CKD 1期比较，^aP＜0.05；与CKD 2期比较，^bP＜0.05；与CKD 3期比较，^cP＜0.05。

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表 3 CKD 1~5期患者HRV相关参数比较(x±s)

分期	例数	SDANN(ms)	SDNN(ms)	pNN50(%)	rMSSD(ms)
CKD 1期	32	119.64±9.64	124.69±10.06	9.84±2.64	32.15±3.68
CKD 2期	39	102.64±8.87^a	113.05±9.55^a	8.30±2.47^a	29.64±3.18^a
CKD 3期	42	85.41±8.51^ab	90.46±9.13^ab	6.14±1.98^ab	25.61±2.87^ab
CKD 4~5期	25	64.25±7.28^abc	72.19±8.02^abc	3.58±1.13^abc	20.16±2.26^abc
F值		217.513	189.289	45.038	83.394
P值		< 0.001	< 0.001	< 0.001	< 0.001
注：与CKD 1期比较，^aP＜0.05；与CKD 2期比较，^bP＜0.05；与CKD 3期比较，^cP＜0.05。

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表 4 影响HRV时域参数的逐步多元线性逐步回归分析

项目	自变量	B	β	SE	t值	P值
SDANN	IL-6	-2.703	-0.295	0.169	2.243	0.029
SDNN	Hb	2.156	0.144	0.141	2.084	0.039
	CRP	-1.480	-0.311	0.529	3.515	< 0.001
	IL-6	-1.368	-0.394	0.337	4.594	< 0.001
	baPWV	-3.418	-0.465	0.407	5.523	< 0.001
pNN50	血磷	-2.419	-0.542	0.277	2.021	0.040
	baPWV	-2.641	-0.305	0.642	2.536	0.014
rMSSD	Hb	2.268	0.215	0.138	2.156	0.031
	IL-6	-6.241	-0.416	0.364	4.417	< 0.001
	血钾	-2.587	-0.205	0.241	2.642	0.018

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