稳定型心绞痛患者中慢性失眠与心脏舒张功能不全的相关性分析

发布时间：2019-01-01 20:52

【摘要】：目的:探讨稳定型心绞痛患者中,慢性失眠与心脏舒张功能不全的相关性及其可能的机制,归纳入组患者中医证型分布,比较不同证型间心脏舒张功能的差异。以期为临床诊断和治疗心脏舒张功能不全提供思路。方法:在稳定型心绞痛患者中,随机选取符合慢性失眠诊断标准的患者183名,按失眠的病程分为4组,第一组6个月-2年,第二组2年-5年,第三组5年-10年,第四组10年。对比4组患者一般情况,高敏C-反应蛋白(hs-CRP),心脏彩超参数及舒张功能等级,HRV(心率变异性)中的SDNN,夜间平均心率的差异性;分析失眠年限与E/E,相关性,与HRV中SDNN相关性,与夜间平均心率的相关性,与高敏C反应蛋白的相关性;基于中医辨证,分析心脏舒张功能患者与中医证型之间的关系;分析慢性失眠患者中医证型之间的关系。结果:1、Pearson相关性分析发现失眠年限与E/E'正相(r=0.712,P0.01),与SDNN呈负相关(r=-0.516,P0.01),与夜间平均心率呈正相关(r=0.742,P0.01),与 hs-CRP 正相关(r=0.715,P0.01)。2、控制变量年龄、性别、高血压、糖尿病、高脂血症,偏相关分析发现现失眠年限与E/E'正相关(r=0.710,P0.01),与SDNN呈负相关(r=-0.509,P0.01),与夜间平均心率正相关(r=0.739,P0.01),与 hs-CRP正相关(r=0.717,P0.01)。3、Spearman分析失眠年限组别与心脏舒张功能等级之间的相关性,发现失眠年限分组与心脏舒张功能等级之间的呈正相关(r=0.659,P0.05)。4、入组患者的中医证型的分布比例不同,从高到低,依次为痰阻心脉证、气阴两虚证、心血瘀阻证、气滞血瘀证、气虚血虚证、阴寒凝滞证、阳气虚衰证、心肾阴虚证。组间比较痰阻心脉证与气滞血瘀证、气虚血虚证、气阴两虚证、心血瘀阻证之间存在统计学差异(P0.05),心血瘀阻证与阴寒凝滞证、阳气虚衰证、痰阻心脉证之间存在统计学差异(P0.05),气虚血虚证与气滞血瘀之间存在统计学差异(P0.05),其他证型之间无统计学差异。结论:1、在本研究中,慢性失眠与心脏舒张功能不全存在相关性,失眠年限越长,心脏舒张功能越低;2、在本研究中,失眠年限与SDNN呈负相关、与夜间平均心率呈正相关、与hr-CRP呈正相关;3、本研究的稳定型心绞痛患者中,慢性失眠的发生可能存在证型分布的差异,其中痰阻心脉型的患者发生率更高。
[Abstract]:Objective: to investigate the relationship between chronic insomnia and cardiac diastolic dysfunction in patients with stable angina pectoris and its possible mechanism, and to summarize the distribution of TCM syndromes in patients with stable angina pectoris, and to compare the difference of cardiac diastolic function among different syndromes. In order to provide ideas for clinical diagnosis and treatment of cardiac diastolic dysfunction. Methods: one hundred and thirty-three patients with stable angina pectoris were randomly divided into 4 groups according to the course of insomnia: the first group was 6 months to 2 years, the second group was 2 to 5 years, and the third group was 5 to 10 years. The fourth group is 10 years old. The differences of SDNN, mean heart rate in Gao Min C-reactive protein (hs-CRP), cardiac color Doppler ultrasound parameters and diastolic grade, HRV (heart rate variability were compared among the four groups. To analyze the correlation between insomnia years and E / E, SDNN in HRV, average heart rate at night and Gao Min C-reactive protein, to analyze the relationship between cardiac diastolic function patients and TCM syndrome type based on TCM syndrome differentiation. To analyze the relationship between TCM syndrome types of chronic insomnia patients. Results: 1Insomnia was negatively correlated with E / E 'positive phase (r = 0.712), SDNN was negatively correlated with SDNN (r ~ (-0.516) P _ (0.01), and was positively correlated with mean heart rate at night (r _ (0. 742) P _ (0.01). (2) Age, sex, hypertension, diabetes, hyperlipidemia, partial correlation analysis showed that the number of years of insomnia was positively correlated with E / E'(r = 0.710 / P0.01). There was a negative correlation with SDNN (r-0.509, P 0.01), a positive correlation with the mean heart rate at night (r = 0.739, P 0.01), and a positive correlation with hs-CRP (r = 0.717, P 0.01). Spearman analysis showed that there was a positive correlation between sleep duration group and cardiac diastolic function grade (r = 0.659P 0.05), and the correlation between sleep duration group and cardiac diastolic function grade was positive (r = 0.659P 0.05). The distribution of TCM syndromes of the patients in the group was different, from high to low, followed by phlegm blocking heart pulse syndrome, qi and yin deficiency syndrome, heart blood stasis syndrome, qi stagnation and blood stasis syndrome, qi deficiency and blood deficiency syndrome, yin cold stagnation syndrome, yang qi deficiency failure syndrome, heart and kidney yin deficiency syndrome. There were statistical differences between the two groups in phlegm obstruction and blood stasis syndrome, qi deficiency and blood deficiency syndrome, qi and yin deficiency syndrome, heart blood stasis syndrome (P0.05), heart blood stasis syndrome and Yin cold stagnation syndrome, Yang Qi deficiency failure syndrome, There was statistical difference between phlegm blocking heart and pulse syndrome (P0.05), there was statistical difference between Qi deficiency and blood deficiency syndrome and qi stagnation and blood stasis (P0.05), but there was no statistical difference among other syndrome types. Conclusion: 1. In this study, chronic insomnia and cardiac diastolic dysfunction have a correlation, the longer the insomnia, the lower the cardiac diastolic function; 2. In this study, the years of insomnia were negatively correlated with SDNN, positively correlated with mean heart rate at night, and positively correlated with hr-CRP. 3. In the patients with stable angina pectoris in this study, the occurrence of chronic insomnia may be different in the distribution of syndromes, among which the incidence of phlegm blocking heart vein type is higher.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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