隐匿性高血压患者心电图P波变化与心率变异性时域和频域指标负相关

王靖炫.隐匿性高血压患者心电图P波变化与心率变异性时域和频域指标负相关[J].内科急危重症杂志,2022,28(6):477-481

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DOI：10.11768/nkjwzzzz20220610

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基金项目:广东省自然科学基金项目（No:2016A030313858）

作者	单位	E-mail
王靖炫	广州医科大学附属第二医院	wenc@126.com

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中文摘要:

摘要目的：分析隐匿性高血压（OH）患者心电图P波变化情况，并探讨其与心率变异性（HRV）的相关性。方法：选择OH患者56例，另选取同期进行健康体检的56例血压正常人群作为对照。比较2组动态血压、P波增宽、P波双峰检出率及HRV相关指标，根据P波起点和P波终点计算最大P波时程（Pmax）、最小P波时程（Pmin）、P波离散度（PWD），采用Pearson相关分析OH患者P波离散度与HRV相关指标的相关性。结果：与对照组比较，OH组患者夜间平均收缩压（SBP）和舒张压（DBP）显著增加，而夜间SBP和DBP下降率显著下降（P均＜0.05）。与对照组比较，OH组左心室肥大、ST T段改变、房室阻滞的患者比例及Pmax、PWD显著增加，正常窦性RR间期的总体标准差（SDNN）、每5min窦性RR间期标准差均值（SDNNin）、正常连续窦性RR间期差值均方根（rMSSD）、相邻RR间期差值＞50ms心搏百分比（pNN50）、高频谱功率（HF）及低频谱功率（LF）显著降低（P均<0.05）。而P波增宽、P波双峰检出率、Pmin比较，差异无统计学意义（P均＞0.05）。OH患者Pmax、PWD与SDNN、SDNNin、rMSSD、pNN50、HF、LF呈负相关（P均＜0.05），而Pmin与HRV指标比较，差异无统计学意义（P均＞0.05）。结论：OH患者早期心电图改变表现为P波增宽和双峰改变，患者Pmax、PWD增大，且与HRV时域和频域指标呈显著负相关。针对OH高危人群，应定期行心电图检查，尽早采取干预措施，以降低不良心血管事件发生的风险。

英文摘要:

Abstract Objective: To analyze the changes of ECG P-wave in patients with occult hypertension (OH) and investigate its correlation with heart rate variability (HRV). Methods: Totally, 56 patients with OH were selected, and 56 volunteers with normal blood pressure who underwent physical examination during the same period were selected as the controls. The ambulatory blood pressure, P-wave broadening, P-wave bimodal detection rate and HRV-related indexes were compared between the two groups. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin) and P-wave dispersion (PWD) were calculated according to the P-wave starting point and P-wave ending point. Pearson correlation was carried out to analyze the relationship between P-wave dispersion and HRV-related indexes in OH patients. Results: Compared with the control group, the mean nocturnal systolic blood pressure and diastolic blood pressure in OH group were significantly increased, while the nocturnal systolic blood pressure and diastolic blood pressure drop rate were significantly decreased (all P< 0.05). Compared with the control group, the left ventricular hypertrophy, ST-T changes, atrioventricular block ratio, Pmax and PWD in OH group increased significantly, while the standard deviation of NN intervals (SDNN), standard deviation of average 5 min NN intervals (SDNNin), root mean square of successive differences in adjacent NN intervals (rMSSD), the percent of adjacent RR intervals with a difference greater than 50ms (pNN50), high frequency (HF) and low frequency (LF) were decreased significantly (all P< 0.05). There were no significant changes in P wave width, P wave bimodal detection rate and Pmin (all P> 0.05). The Pmax and PWD were significantly negatively correlated with SDNN, SDNNin, rMSSD, pNN50, HF and LF in OH patients (all P< 0.05), while Pmin was not significantly correlated with HRV indicators (all P> 0.05). Conclusion: ECG P-wave broadening and bimodal changes are the early manifestations of cardiac electrical damage in OH, Pmax and PWD increase in patients, and there is a significantly negative correlation with HRV time domain and frequency domain indexes. For the high-risk group of OH, ECG should be checked regularly, and early intervention measures should be taken to reduce the risk of adverse cardiovascular events.