鄭菊 尤華 吳雁鳴 南通大學附屬吳江市第一人民醫院心內科（吳江，215200，中國）
摘要  目的  探討不穩定心絞痛（unstable angina pectoris，UAP）患者竇性心率震蕩（heart rate turbulence ,HRT）的變化及臨床意義。方法 選擇2005.1～2007.2住院幷確診的UAP 患者46例，按照冠脉狹窄程度累計積分法分爲輕度狹窄組(n=14) 、中度狹窄組(n=14)和重度狹窄組(n=18)，健康對照組57例，所有患者均接受動態心電圖（ambulatory electrocardiogram,AECG）檢查，測量竇性心率震蕩的參數震蕩起始（TO）和震蕩斜率（TS）。結果 UAP 患者TO較對照組顯著升高，TS較正常對照組患者顯著降低，冠脉狹窄程度越重竇性心率震蕩减弱越明顯，相關性分析表明冠脉狹窄程度與TO正相關，與TS負相關。結論 HRT可作爲檢測UAP患者壓力感受器敏感性减退和自主神經功能受損，尤其是迷走神經反射功能受損，以及判斷UAP患者冠脉狹窄嚴重程度的有用參考指標。
關鍵詞  不穩定心絞痛 竇性心率震蕩 心率變异 動態心電圖
The Changes and Clinical Significances of Heart Rate Turbulence in Patients with unstable angina pectoris
ZHENG Ju,YOU Hua,WU Yan Ming.The department of cardiology,the affiliated first people hospital of WuJiang hospital of NanTong University(WuJiang，215200，China)
Corresponding author: HONG Xiao-su, Email: zhengju2004@163.com
Abstract Objective TO investigate the changes and clinical significances of heart rate turbulence in patients with unstable angina pectoris. Methods  Total 46 patients with unstable angina pectoris in the heart medicine wards were chosen from Jan.2005 to Feb. 2007. Three groups that’s low-grade narrow group(n=14) 、middle-grade narrow group(n=14) and serious narrow group(n=18) were obtained in the unstable angina pectoris group by the difference of the coronary arterial narrow level .57 control subjects without organic heart diseases were enrolled. All subjects were performed 24-hour ambulatory electrocardiogram.The 24-hour Holter record of each subject was processed by Holter 12.0 TOP Version HRT  analysis  software. HRT are stated by two parameters:TO and TS.The parameters of HRT and heart rate variability (HRV) were obtained by software directly . Results  Compared with the control group, the value of  TO was signigicantly higher in UAP patients while the value of TS was significantly lower in UAP patients. TO are postively related to the degree of the narrow of the coronary artery in the UAP patients while TS are negatively related to the degree of the narrow of the coronary artery in the UAP patients. Conlusion  The lessened HRT in patients of UAP showed the cardiac autonomic nerve function , especially the vagus function , and the baroreceptor  sensitivity was impaired. Meanwhile HRT can be a useful marker to evaluate the severity of the narrow of the coronary artery in the UAP patients.
Keywords  unstable angina pectoris;heart rate turbulence;heart rate variability;ambulatory electrocardiogram
近年來研究發現，竇性心率震蕩（heart rate turbulence，HRT）可以反映心臟自主神經的調節功能，是判斷冠心病發生心梗猝死危險的一個重要指標[1]。不穩定心絞痛（unstable angina pectoris，UAP）患者是冠心病患者中的一特殊人群，目前對HRT與UAP患者冠狀動脉病變程度之間的關係研究甚少，因此，本研究對行冠脉造影的UAP患者同期進行動態心電圖監測，分析UAP患者HRT與冠狀動脉病變及其嚴重程度之間的關係。