不同Antzelevitch分型心室早复极患者心率变异性和减速力及心室复极离散度研究

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摘要目的研究不同Antzelevitch分型心室早复极患者的心率变异性（HRV）和心率减速力（DC）及心室复极离散度在其自主神经功能异常评估中的作用。方法选择2016年1月～2018年12月在上海健康医学院附属上海市第六人民医院东院诊治的心室早复极患者126例，给予心电图及动态心电图检查。根据Antzelevitch分型法将其分为三组：Ⅰ型组50例，Ⅱ型组41例，Ⅲ型组35例。另外选择同时期健康体检者50例为对照组。比较各组入选者的心率加速力（AC）、心率减速力（DC）和心率变异性（HRV）及心室复极离散度变化，并分析其相关性。结果早复极Ⅱ型组、Ⅲ型组患者DC、24 h正常窦性R-R间期的标准差（SDNN）、和全程相邻正常R-R间期之差的均方根值（RMSSD）值均低于对照组（P ＜ 0.05或P ＜ 0.01）；Ⅱ型和Ⅲ型组心率加速力（AC）和心电图T波峰-末间期（Tp-Te）值明显高于对照组（均P ＜ 0.05）；与Ⅰ型组比较，Ⅲ型组DC、SDNN值也明显降低，AC值明显增高（均P ＜ 0.05）；早复极患者DC与SDNN、RMSSD和24 h内差值＞50 ms的连续正常的R-R间期数所占的百分数（PNN50）呈正相关（r = 0.3318，P ＜ 0.01；r = 0.2777，P ＜ 0.05；r = 0.2916， P ＜ 0.01），与AC和Tp-Te呈负相关（r = -0.8084，P ＜ 0.001；r = -0.1913，P ＜ 0.05）。结论不同Antzelevitch分型心室早复极患者存在不同程度自主神经功能异常，Tp-Te间期延长，其中Ⅲ型组自主神经功能失衡更加明显，通过对其DC和HRV及心室复极离散度的研究，可以为临床诊疗提供帮助。

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	申淑荣王兴德周丽曾金美陈彬陈忠

关键词 ：自主神经功能, 心室早复极, 心率减速力, T波峰-末间期

Abstract：Objective To investigate the role of heart rate variability (HRV), deceleration capacity (DC) and ventricular repolarization dispersion in the assessment of autonomic nervous dysfunction in patients with different Antzelevitch classification of ventricular early repolarization. Methods From January 2016 to December 2018, 126 patients with ventricular early repolarization who were diagnosed and treated in Shanghai Sixth People′s Hospital East Affiliated to Shanghai University of Medicine and Health Science were selected for electrocardiogram and dynamic electrocardiogram examination. According to Antzelevitch classification method, they were divided into three groups: type Ⅰ group of 50 cases; type Ⅱ group 41 cases; type Ⅲ group 35 examples. In addition, 50 cases of healthy physical examination in the same period were selected as the control group. The heart rate acceleration (AC), DC, HRV and ventricular repolarization dispersion of each group were compared and the correlation was analyzed. Results The DC, 24 h period of standard deviation of normal sinus R-R intervals (SDNN), and the root mean square of standard deviations of differences between adjacent normal R-R intervals (RMSSD) of type Ⅱ group and type Ⅲ group early repolarization patients were lower than those of the control group (P ＜ 0.05 or P ＜ 0.01). In type Ⅱ and Ⅲ groups, the AC and electrocardiogram T peak-T end interval (Tp-Te) was significantly higher than those of the control group (all P ＜ 0.05); compared with type Ⅰ group, the DC, SDNN value in type Ⅲ group also significantly reduced, AC value increased significantly (all P ＜ 0.05); in patients with early repolarization, DC was positively correlated with SDNN, RMSSD and the percentage of continuous normal R-R intervals with a difference of more than 50 ms within 24 h (PNN50) (r = 0.3318, P ＜ 0.01; r = 0.2777, P ＜ 0.05; r = 0.2916, P ＜ 0.01), which was negatively correlated with AC and Tp-Te (r = -0.8084, P ＜ 0.001, r = -0.1913, P ＜ 0.05). Conclusion Patients with different Antzelevitch classification of ventricular early repolarization have different degrees of autonomic nervous dysfunction and the Tp-Te internal is prolonged, among which the autonomic nervous dysfunction of type Ⅲ group is more obvious. The study on DC and HRV and ventricular repolarization dispersion can provide help for clinical diagnosis and treatment.

Key words： Autonomic nervous function Ventricular early repolarization Deceleration capacity T peak-T end interval

基金资助:上海健康医学院种子基金项目（SFP-18-22-14-017）；
上海申康医院发展中心临床科技创新项目（SHDC120 16238）。

通讯作者: 王兴德（1965.10-），男，硕士，主任医师；研究方向：高血压、心电生理与心律失常。

引用本文:

申淑荣王兴德周丽曾金美陈彬陈忠. 不同Antzelevitch分型心室早复极患者心率变异性和减速力及心室复极离散度研究[J]. 中国医药导报, 2019, 16(35): 65-68.
SHEN Shurong WANG Xingde ZHOU Li ZENG Jinmei CHEN Bin CHEN Zhong. Study on heart rate variability, deceleration capacity and ventricular repolarization dispersion in patients with different Antzelevitch classification of ventricular early repolarization. 中国医药导报, 2019, 16(35): 65-68.

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