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目的:探讨扩张型心肌病(DCM)患者心率加速力(AC)和减速力(DC)变化的临床意义。方法:选择43例DCM患者(DCM组)和41例无器质性心脏病患者(对照组)行心脏超声心动图和24h动态心电图检查,比较两组间AC值、DC值及心率变异性(HRV)指标的差别;DCM患者按DC值分为低、中、高危3组,比较3组间AC值、DC值、左房内径(LAd)、左室舒张末径(LVEDd)和左室射血分数(LVEF)的差别,并分析上述指标间的相关性。结果:与对照组相比,DCM组患者AC值增加[(-8.30±1.88)ms︰(-5.10±2.47)ms,P<0.01]、DC值降低[(7.90±1.94)ms︰(4.00±2.00)ms,P<0.01],HRV指标SDNN、LF和vLF均降低(均P<0.05)。与低危组相比,DCM中危组AC值增加[(-6.80±1.81)ms︰(-3.90±0.90)ms,P<0.01]、DC值降低[(6.40±1.56)ms︰(3.70±0.50)ms,P<0.01),但高危组AC值[(-5.80±4.32)ms]和DC值[(1.30±0.96)ms]较中危组均降低(P<0.01);DCM低、中、高危3组间LAd差别有统计学意义[(45.30±7.42)mm、(51.90±6.95)mm、(54.90±11.14)mm,P<0.01]。DCM患者AC值与LAd(r=0.473,P<0.01)、LVEDd(r=0.441,P<0.01)呈正相关,与LVEF呈负相关(r=-0.569,P<0.01);DC值与LAd(r=-0.505,P<0.01)、LVEDd(r=-0.421,P<0.01)呈负相关,与LVEF呈正相关(r=0.632,P<0.01)。结论:AC和DC评价自主神经功能优于HRV指标;DCM患者自主神经功能受损,与心脏本身病变进展相关。
Objective: To investigate the clinical significance of changes of heart rate acceleration (AC) and deceleration (DC) in patients with dilated cardiomyopathy (DCM). Methods: Forty-three patients with DCM (DCM group) and 41 patients without organic heart disease (control group) underwent echocardiography and 24h electrocardiogram. The AC value, DC value and heart rate variability HRV). DCM patients were divided into low, medium and high risk groups according to the DC value. The AC value, DC value, LAd, LVEDd and left ventricular ejection fraction (LVEF) differences, and analyze the correlation between the above indicators. Results: Compared with the control group, ACD in DCM patients increased (-8.30 ± 1.88) ms: (-5.10 ± 2.47) ms, P <0.01] 2.00) ms, P <0.01]. The HRV indexes SDNN, LF and vLF decreased (all P <0.05). Compared with the low-risk group, the AC value in DCM group increased [(-6.80 ± 1.81) ms: (-3.90 ± 0.90) ms, P <0.01] 0.50) ms, P <0.01). However, the AC value [(-5.80 ± 4.32) ms] and DC (1.30 ± 0.96 ms) in high risk group were lower than those in moderate risk group (45.3 ± 6.92) mm, (51.90 ± 6.95) mm, (54.90 ± 11.14) mm, respectively, P <0.01]. The AC in DCM patients was positively correlated with LAd (r = 0.473, P <0.01), LVEDd (r = 0.441, P <0.01) and negatively correlated with LVEF There was a negative correlation between LVEDd (r = -0.421, P <0.01) and LVEF (r = -0.505, P <0.01). CONCLUSION: AC and DC are superior to HRV in evaluating autonomic function. Autonomic dysfunction in patients with DCM is associated with the progression of the heart itself.