冠心病痰热证患者HRV与CA特征及相关性研究

发布时间：2018-01-13 19:38

本文关键词：冠心病痰热证患者HRV与CA特征及相关性研究　出处：《北京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：通过对HRV与CA特征与相关性研究,可以探知冠心病痰热证患者自主神经功能状况,同时可以为冠心病预防与监测提供更加广泛的检验方法,从而降低冠心病的患病率与死亡率。研究方法：冠心病诊断标准参照中华医学会心血管病分会2007年制定的《慢性稳定型心绞痛诊疗指南》、《不稳定性心绞痛和非ST段抬高型心肌梗死诊疗指南》以及2002年由ACC/AHA发布的《ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segmentelevation myocardial infarction》等相关指南制定。痰热证中医诊断标准参照北京市科委首都特色医疗项目“基于心主血脉一神明论的连夏宁心方干预冠心病心绞痛临床疗效研究”课题组诊断标准。对115名冠心病痰热证患者进行24h动态心电图检测,并进行时域分析以及血浆儿茶酚胺(CA)监测；通过对其进行相关性分析,得出痰热证患者心率变异性与儿茶酚胺特点与相关性分析。结果与结论：在本次研究当中,部分患者出现HRV的下降趋势,意味着自主神经功能受到了一定损害。冠心病痰热证患者有明显的交感神经兴奋性升高,而且不同性别、年龄、合并症都有所差异,自主神经均有不同程度的损伤。冠心病痰热证患者HRV时域指标中的SDNN较正常值偏低,SDANN亦有所降低,PNN50与RMSSD却有不同程度的升高：频域指标中,VLF与SDANN具有很强相关性,较正常值有所上升,HF代表迷走神经兴奋性,亦有升高趋势。由此可以假设冠心病痰热证患者交感神经张力有所上升,迷走神经张力亦有一定提高。儿茶酚胺是调节性激素,也是体内一种重要的神经递质。可调节心血管活动,包括交感神经末梢释放的多巴胺,去甲肾上腺素和肾上腺髓质释放肾上腺素。在正常情况下,主要的生理功能是通过作用于肾上腺素能受体(a和β)和多巴胺受体,血管,增强心肌收缩力,增加心肌细胞的兴奋性,是一种重要的神经体液的激素来维持人体的生理功能。儿茶酚胺指标中去甲肾上腺素明显升高,而肾上腺素与多巴胺略有降低。本研究通过对冠心病痰热证患者CA与HRV的相关性研究分析发现,经过比较心率变异性指标SDNN-24h、SDNN-index、SDANN-index、总功率、极低频率、低频功率和高频功率与儿茶酚胺指标肾上腺素呈正相关,有统计学意义(p0.05),其余的心率变应性指标与儿茶酚胺指标均没有相关关系。极低频率和低频功率与SDNN-24h、SDNN-index、SADNN-index有很强的相关性；高频功率与SDNN-24h和SDNN-index也有很强的相关性。同时痰热证积分与SDANN呈显著正相关。以上结果表明,冠心病痰热证患者自主神经受到损害,交感神经兴奋性升高,而儿茶酚胺中的肾上腺素与之有显著相关性,可以肾上腺索的变化推测冠心病患者自主神经功能异常,在临床应用中可以更好的监测冠心病自主神经功能。
[Abstract]:Objective: to explore the autonomic nervous function of patients with sputum heat syndrome of coronary heart disease by studying the characteristics and correlation between HRV and CA, and to provide a more extensive test method for prevention and monitoring of coronary heart disease. In order to reduce the prevalence and mortality of coronary heart disease. Methods: the diagnostic criteria for coronary heart disease refer to the Chinese Medical Association Cardiovascular Association in 2007 formulated the "chronic stable angina pectoris diagnosis and treatment guidelines". "guidelines for the diagnosis and treatment of unstable angina Pectoris and Non-ST-segment elevation Myocardial Infarction" and < ACC/AHA 2002 guideline issued by ACC/AHA on 2002. Update for the management of patients with unstable angina and. Non-ST-segmentelevation myocardial. Infarction > and other related guidelines. The diagnostic criteria of phlegm and heat syndrome in traditional Chinese medicine refer to the Beijing Science and Technology Commission Capital characteristic Medical Project. " Study on the Clinical effect of Lianxia Ningxin recipe on intervention of angina Pectoris of Coronary Heart Disease based on the Theory of Heart, Blood, vein and Divinity. The Diagnostic criteria of the Group. 115 patients with sputum Heat Syndrome of Coronary Heart Disease were detected by 24h dynamic electrocardiogram. Time domain analysis and plasma catecholamine CAA monitoring were performed. Through the correlation analysis, the heart rate variability and catecholamine characteristics and correlation analysis of patients with phlegm heat syndrome. Results and conclusions: in this study, some patients showed a downward trend of HRV. It means that autonomic nervous function has been damaged. Coronary heart disease sputum heat syndrome patients have obvious increase of sympathetic excitability, and different sex, age, complications are different. The SDNN in time domain index of HRV in patients with sputum heat syndrome of coronary heart disease was lower than the normal value. However, PNN50 and RMSSD increased in varying degrees: there was a strong correlation between VLF and SDANN in frequency-domain indexes, and the increase of HF compared with normal value indicated vagus nerve excitability. It can be assumed that sympathetic tension and vagal tension in patients with sputum heat syndrome of coronary heart disease have increased. Catecholamine is the regulating sex hormone. It is also an important neurotransmitter in the body. It regulates cardiovascular activity, including the release of dopamine, norepinephrine, and adrenomedullary adrenaline from sympathetic nerve endings. The main physiological function is to enhance myocardial contractility and increase the excitability of cardiac myocytes by acting on adrenergic receptors (A and 尾) and dopamine receptors, blood vessels. Catecholamine is an important neurohumoral hormone to maintain the physiological function of human body. By analyzing the correlation between CA and HRV in patients with phlegm heat syndrome of coronary heart disease, we found that the heart rate variability index (SDNN-24h) was compared. SDNN-indexs SDANN-index, total power, very low frequency, low frequency power and high frequency power were positively correlated with epinephrine. There was no correlation between the other indexes of HR and catecholamine. The very low frequency and low frequency power were correlated with SDNN-24h SDNN-index. SADNN-index has strong correlation; The high frequency power also had strong correlation with SDNN-24h and SDNN-index, and the score of phlegm heat syndrome was positively correlated with SDANN. The autonomic nerve was damaged and sympathetic nerve excitability was increased in patients with phlegm heat syndrome of coronary heart disease, and epinephrine in catecholamine was significantly correlated with it. The changes of adrenal cord can infer the abnormal autonomic nervous function in patients with coronary heart disease and can better monitor the autonomic nerve function of coronary heart disease in clinical application.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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