慢性肾脏病患者心率变异性的特点及其影响因素分析

发布时间：2018-05-31 20:33

本文选题：慢性肾脏病 + 心率变异性　；参考：《复旦学报(医学版)》2017年01期

【摘要】：目的探讨慢性肾脏病(chronic kidney disease,CKD)患者心率变异性(heart rate variability,HRV)的特点及影响因素。方法根据e GFR水平将250例透析前的CKD患者分成CKD1~5期组,所有患者行HRV检测(SDNN、SDNNI、RMSSD、PNN50),分析各期CKD患者HRV特点,并检测尿液指标尿白蛋白、尿肌酐等及血清学指标血常规、肾功能、糖代谢指标、血脂、电解质、C反应蛋白(C-reactive protein,CRP)、同型半胱氨酸(homocysteine,Hcy)、甲状旁腺素(parathyroid hormone,PTH)等,探讨HRV的影响因素。结果 CKD1~5期患者中HRV降低的比例分别为14.29%、54.90%、73.68%、80.43%和94.44%,除CKD3期和4期两组间比较差异无统计学意义(P0.05),其余各组间比较差异均有统计学意义(P0.05)。SDNN、SDNNI、RMSSD、PNN50在CKD1~5期患者间均呈逐渐减小趋势,与肾功能水平、血脂、血糖、PTH、Hcy、CRP、贫血、电解质、尿白尿白排泄率等指标呈显著相关。结论 CKD患者普遍存在HRV降低,且随着肾功能恶化不断加重。CKD患者HRV降低与其肾功能水平、脂代谢紊乱、糖代谢异常、贫血、继发性甲状旁腺功能亢进、微炎性状态、高Hcy血症、电解质异常及尿白蛋白排泄率增高等因素有关。
[Abstract]:Objective to investigate the characteristics and influencing factors of heart rate variability (HRV) in patients with chronic kidney disease. Methods according to the level of e GFR, 250 patients with CKD before dialysis were divided into CKD1~5 stage group. All the patients were examined by HRV. The HRV characteristics of CKD patients in each stage were analyzed, and urine albumin, urinary creatinine, serum routine examination and renal function were detected. Glucose metabolism, lipid, electrolyte C-reactive protein (CRP), homocysteine (HCH), parathyroid (PTH), and so on. Results the decrease rate of HRV in CKD1~5 patients was 14.29% and 73.68%, respectively. Except for CKD3 stage and stage 4, there was no significant difference between the two groups (P 0.05), but there was a significant difference between the other groups (P 0.05, P 0.05). The SDN50 of RMSSDNNIRMS SDNN50 decreased gradually among the patients in CKD1~5 stage. There was a significant correlation between renal function level, blood lipid, blood glucose, PTH, HcyP, anemia, electrolyte, urinary white excretion rate and so on. Conclusion the decrease of HRV is common in patients with CKD, and with the worsening of renal function, the decrease of HRV in patients with CKD is related to the renal function level, lipid metabolism disorder, abnormal glucose metabolism, anemia, secondary hyperparathyroidism and microinflammatory state. Hyperthermia, electrolyte abnormality and increased urinary albumin excretion rate were related.
【作者单位】：复旦大学附属金山医院肾内科;复旦大学附属金山医院中心实验室;
【基金】：复旦大学附属金山医院优秀青年人才项目上海市金山区卫计委青年项目(JSKJ-KTQN-2015-08)~~
【分类号】：R692

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