南方医科大学学报

南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (05): 713-.

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原发性高血压患者昼夜节律与自主神经功能及心肌能量消耗的相关性

沈安娜，郑德仲，胡兆霆   

  • 出版日期:2014-05-20 发布日期:2014-05-20

Associations of circadian blood pressure rhythm with autonomic nervous system and
myocardial energy expenditure level in patients with primary hypertension

  • Online:2014-05-20 Published:2014-05-20

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摘要： 目的探讨高血压患者血压昼夜节律与自主神经功能及心肌能量消耗（MEE）的关系。方法选取我院2012年1月~2013
年1月的初诊原发性高血压患者102例为高血压组，根据24 h动态血压结果，按照夜间血压下降率分为两组：<10%为非杓型组
（NDH=54例），≥10%为杓型组（DH=48例）。同时选取45例健康者为对照组。应用动态心电图检测高血压各组及对照组的心
率变异性，应用心脏超声技术检查各组的心肌能量消耗水平。比较DH、NDH组及对照组的心率变异性（HRV）及MEE水平，分
析其相关性。结果（1）HRV：与健康对照组相比，高血压组（DH 组及NDH 组）HRV 时域指标SDNN、SDANN、SDNNindex、
RMSSD、PNN50 均明显降低，频域指标HF 明显降低，而LF/HF 明显增高（P<0.05）；与DH组相比，NDH组HRV时域指标
（SDNN、SDANN、SDNNindex、RMSSD）均有明显下降（P<0.05），频域指标HF 明显降低，而LF/HF 明显增高（P<0.05）；（2）
MEE：与健康对照组相比，高血压组患者MEE明显升高（P<0.05）；与DH组相比，NDH组MEE明显升高（P<0.05）；（3）双变量相
关分析显示：MEE与SDANN、RMSSD、HF、EF均呈负相关，与LVMI、E/E’呈正相关，其中高血压组MEE与SDANN显著相关
（r=-0.521）。结论原发性高血压患者存在自主神经功能损害，其中NDH组较DH组交感神经和副交感神经均衡性受损更加严
重；多普勒超声心动图无创检测原发性高血压患者的MEE水平可反映不同昼夜节律高血压患者心肌生物能量消耗的特点，非
杓型高血压患者MEE水平升高更为显著；高血压患者MEE升高与交感神经兴奋有关；高血压临床实践中需注重恢复血压昼夜
节律。

Abstract: Objective To investigate the relationship among circadian blood pressure rhythm, autonomic nervous system and
myocardial energy expenditure (MEE) level in patients with primary hypertension. Methods A total of 102 hypertensive and
45 normotensive subjects were recruited. According to blood pressure reduction rate at night, the hypertensive patients were
divided into non-dipper group (NDH group, n=54) with a reduction rate of <10% and dipper group (DH group, n=48) with a
reduction rate of ≥10%. The circadian blood pressure rhythm and heart rate variability were measured with ambulatory blood
pressure monitoring and 24-hour electrocardiograph monitoring, respectively, and MEE was measured by Doppler
echocardiography to analyze their correlations. Results SDNN, SDANN, SDNNindex, RMSSD, PNN50, and HF were
significantly lower in the hypertensive patients than in the control group (P<0.05); these parameters, except for PNN50, were
all significantly lower in NDH group than in DH group (P<0.05). The hypertensive patients had significantly higher MEE than
the control group (P<0.05), and MEE was significantly higher in NDH group than in DH group (P<0.05). Bivariate correlation
analysis showed significant correlations of MEE with SDANN in the hypertensive patients (P<0.01). Conclusion Patients with
primary hypertension, especially those in NDH group, have impaired autonomic nervous system function. The hypertensive
patients in NDH group show a more prominent increase in MEE in relation to sympathetic activation, suggesting the
importance of restoring circadian blood pressure rhythm in the treatment of hypertension.