心率变异性诊断血管迷走性晕厥的作用及与血常规参数的关系

The role of heart rate variability in the diagnosis of vasovagal syncope and its relationship with blood routine parameters

摘要:

目的 探讨心率变异性（HRV）诊断血管迷走性晕厥（VVS）的作用及其与血常规参数的关系。方法 选取2015年7月—2019年1月在徐州市中心医院就诊的有晕厥史的92例患者。均于入院后行直立倾斜试验（HUT）并给予24 h动态心电监测。HUT中57例阳性反应者作为阳性组，35例阴性反应者作为阴性组，另选取同期40例健康群众作为对照组，统计全部窦性心搏间标准差（SDNN）、全程相邻心搏间之差的均方根（MSSD）、全部5分钟时间段窦性心搏间标准差的均值（SDNNi）、相邻心搏间之差> 50 ms的心搏数占总心搏数的百分率（pNN50）、三角指数（TI）、总功率（TP）、极低频功率（VLF）、低频功率（LF）、高频功率（HF）的水平。于24 h心电监测结束后对比各组SDNN、SDNNi、MSSD、PNN50、TI、TP、VLF、LF及HF的水平。分析心率变异性参数对诊断VVS的评价效能。对比阳性组，阴性组和对照组血常规参数红细胞（RBC）、血红蛋白（HGB）、平均红细胞血红蛋白含量（MCH）及血小板计数（PLT）水平。分析阳性组HRV各参数与血常规参数的相关性。结果 阳性组TP、VLF、LF及HF水平较阴性组和对照组高。联合检测的敏感性和AUC最高（P <0.05），LF的特异性最高（P <0.05），阳性组HGB、MCH、PLT水平较阴性组和对照组高（P <0.05），血清HGB、MCH及PLT水平分别与TP、VLF、LF及HF呈正相关（P <0.05）。结论 VVSHUT阳性患者的HRV存在异常，TP、VLF、LF和HF联合诊断VVS的效能较理想，可以联合应用于临床，HUT阳性患者血液中HGB、MCH及PLT水平升高，且与TP、VLF、LF及HF呈正相关。

Abstract:

Objective To investigate the role of heart rate variability (HRV) in the diagnosis of vasovagal syncope and its relationship with blood routine parameters.Methods The clinical data of 92 patients with a history of syncope who visited our hospital from July 2015 to January 2019 were analyzed retrospectively. After being admitted to the hospital, the head-up tilt test (HUT) was taken and the 24-hour dynamic electrocardiogram (ECG) monitoring was carried out. Patients tested positive and negative for HUT were separately divided into positive group (57 cases) and negative group (35 cases), and another 40 cases of healthy individuals during the same period were set as control group. The standard deviation of NN intervals (SDNN), mean of the standard deviations of all the NN intervals for each 5 min segment of a 24 h HRV recording (SDNNi), root mean square of successive RR interval differences (MSSD), percentage of successive RR intervals that differ by more than 50 ms (pNN50), triangular index (TI), total power (TP), very-low-frequency power (VLF), low-frequency power (LF) and high-frequency power (HF) were measured. The levels of SDNN, SDNNi, MSSD, PNN50, TI, TP, VLF, LF and HF in positive group, negative group and control group were compared after 24 h ECG monitoring. The efficacy of HRV parameters in the diagnosis of vasovagal syncope was analyzed. The levels of red blood cell count (RBC), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), and platelet count (PLT) in the positive group, negative group, and control group were compared. The correlation between HRV parameters and blood routine parameters in positive group was analyzed.Results The levels of TP, VLF, LF and HF in positive group were higher than those in negative group and control group (P < 0.05). The sensitivity and area under the receiver operating characteristic curve (AUC) of the combination of TP, VLF, LF and HF for diagnosing vasovagal syncope were the highest (P < 0.05), while the specificity of LF was the highest (P < 0.05). The levels of HGB, MCH and PLT were greater in the positive group compared with negative group and control group (P < 0.05). Besides, the levels of HGB, MCH and PLT were positively correlated with TP, VLF, LF and HF, respectively (P < 0.05).Conclusions The HRV is abnormal in HUT-positive patients with vasovagal syncope. The efficacy of the combination of TP, VLF, LF and HF in the diagnosis of vasovagal syncope is great, and it can be considered in clinical practice. The levels of HGB, MCH and PLT are increased, and the blood routine parameters are positively correlated with HRV in HUT-positive patients.