标题：心率变异性与动态血压持续监测在肾性高血压与原发性高血压中的应用

      作者：裴林林 1，姜国刚 2，刘玮 1，孙卫红 1，陈宗建 1，章向东 1
    （1.昆山市第二人民医院心内科，江苏 昆山 215300；
2.昆山市第三人民医院，江苏 昆山 215300）

      卷次： 2016年27卷11期

      【摘要】 目的 探讨心率变异性(HRV)与动态血压持续监测在肾性高血压与原发性高血压中的临床应用效
果。方法 选择2012年4月至2014年12月昆山第二人民医院心内科收治的肾性性高血压、原发性高血压患者及
健康体检者共118例，分为肾性高血压组42例、原发性高血压组46例和正常对照组30例，对三组受检者同时进行
24 h动态血压及动态心电图监测，观察动态血压变量、心律失常发生率及HRV时域指标并进行统计分析。结果 肾性
高血压组、原发性高血压组与正常对照组非勺型高血压发生率分别为73.8% (31/42)、23.9% (11/46)、10.0% (3/30)；心律
失常发生率分别为69.0% (29/42)、43.4% (20/46)、10.0% (3/30)，肾性高血压组非勺型高血压与心律失常的发生率较原
发性高血压增高(P=0.01、0.01)，较正常对照组明显增高。肾性高血压24 h内全部窦性心律RR间期平均值的标准差
(SDNN)与24 h内每5 min窦性RR间期标准差的平均值(SDNN index)低于原发性高血压[分别为(59.2±19.5) ms vs
(95.4±25.2) ms、(17.5±6.3) ms vs (40.4±12.5) ms，P<0.05]，但 24 h平均心率，相邻R-R间期的差值超过 50 ms的心搏
数占监测心搏数的百分比(PNN50)，相邻R-R间期差的均方根(RMSSD)与原发性高血压差异无统计学意义(P>
0.05)。结论 肾性高血压患者非勺型高血压较正常及原发性高血压明显增多，心率变异性降低，夜间更易发生心
律失常。

      【关键词】 肾性高血压；原发性高血压；动态血压；心率变异性

      【中图分类号】 R544.1+4 【文献标识码】 A 【文章编号】 1003—6350（2016）11—1741—03


Clinical application of heart rate variability and ambulatory blood pressure monitoring in renal hypertension and
essential hypertension.
PEI Lin-lin 1, JIANG Guo-gang 2, LIU Wei 1, SUN Wei-hong 1, CHEN Zong-jian 1, ZHANG
Xiang-dong 1. 1. Department of Cardiology, the Second People's Hospital of Kunshan, Kunshan 215300, Jiangsu, CHINA; 2.
The Third People's Hospital of Kunshan, Kunshan 215300, Jiangsu, CHINA

【Abstract】 Objective To explore clinical application of heart rate variability (HRV) and ambulatory blood
pressure monitoring in renal hypertension and essential hypertension. Methods A total of 118 patients with renal hyper-
tension and essential hypertension in the Second People's Hospital of Kunshan from April 2012 to December 2014 were se-
lected and divided into renal hypertension group (42 cases), essential hypertension group (46 cases) and normal control
group (30 cases). 24 hours ambulatory blood pressure and ambulatory ECG monitoring were performed in three groups, to
observe the dynamic blood pressure, the incidence rate of arrhythmia and the HRV time domain indexes. Results The in-
cidence of nondipper hypertension in renal hypentension group, essential hypertension group and normal control group
were 73.8% (31/42), 23.9% (11/46) and 10.0% (3/30), respectively, and incidence of arrhythmia in three groups were
69.0% (26/42), 43.4% (20/42) and 10.0% (3/30), respectively. The incidences were higher in renal hypertension group
than essential hypertension group (P=0.01, 0.01), and significantly higher than normal control group. Standard devia-
tion of NN intervals (SDNN) and SDNN index in renal hypertension group was lower than those in essential hyperten-
sion group [(59.2±19.5) ms vs (95.4±25.2) ms, (17.5±6.3) ms vs (40.4±12.5) ms, P<0.05]. The 24 hours mean heart rate,
percentage of differences between adjacent normal RR intervals exceeding 50 milliseconds, PNN50 and root mean
square of successive differences of R-R intervals (RMSSD) were not significantly different between two groups (P>
0.05). Conclusion The ratio of renal hypertension patients with nondipper type hypertension is significantly increased
compared with normal and essential hypertension, and heart rate variability is reduced. The night is more prone to cardi-
ac arrhythmia.

      【Key words】 Renal hypertension; Essential hypertension; Ambulatory blood pressure; Heart rate variability
·论 著·
6350.2016.11.005