洛伦兹散点图心率变异性分析在心脏病患者中的临床应用研究-现代医学

洛伦兹散点图心率变异性分析在心脏病患者中的临床应用研究

单位：北京市海淀医院心内科-心功能室, 北京 100080

分类号：R541.7;R540.41

出版年·卷·期（页码）：2018·37·第九期（992-996）

摘要：

目的：探索洛伦兹（Lorenz）散点图心率变异性（heart rate variability，HRV）分析在心脏病患者中的临床应用价值。方法：随机选取我院2017年7月至2017年12月拟诊心脏病的患者170例为拟诊组，最终确诊心脏病的患者为心脏病组，非心脏病患者为非心脏病组；随机选取来我院进行体检的健康者100例为对照组。所有入选者进行动态心电图检查并对资料进行分析，制作、观察并比较心脏病组和对照组患者的Lorenz散点图形态以及散点图长度（length，L）和离散度（dispersion，D），分析比较心脏病组、对照组患者时域频域指标24 h内所有窦性R-R间期的标准差（SDNN）、患者24 h内每5 min窦性R-R间期的标准差（SDANN）、患者24 h内所有相邻窦性R-R间期差值均方根（rMSSD）、低频功率（low-frequency power，LF）、高频功率（high frequency power，HF）。比较拟诊组心脏病患者Lorenz散点图和时域频域指标分析的检验效能，并与临床诊断结果进行一致性分析。结果：170例拟诊心脏病患者中136例确诊为心脏病患者，34例为非心脏病患者。心脏病组SDNN、SDANN、L、HF、LF均显著低于对照组（P<0.05），而心脏病组D又显著高于对照组（P<0.05），差异均有统计学意义，两组rMSSD参数比较差异无统计意义（P>0.05）。心脏病组与对照组鱼雷状、梭状、短棒状散点图例数差异无统计学意义（P>0.05）；对照组彗星状（91.00%）例数显著高于心脏病组（9.56%）（P<0.05），而心脏病组扇形状（17.65%）和复杂性（58.09%）例数显著高于对照组（0%、4.00%）（P<0.05），差异均有统计学意义。Lorenz散点图异常的特异性、阳性预测值、准确率显著高于时域频域指标异常（P<0.05），差异有统计学意义。两种检查方法与临床诊断标准一致性评价中Lorenz散点图与临床诊断标准一致性评价的kappa值为0.783，时域频域分析与临床诊断标准一致性评价的kappa值为0.606。结论：心脏病患者时域频域指标较正常人降低、Lorenz散点图离散度增大；心脏病患者Lorenz散点图主要表现为扇形状、复杂性，正常人主要表现为彗星状；Lorenz散点图HRV对于心脏病有较高的诊断价值，可作为临床判断HRV的重要手段，具有重要的临床价值和意义。

Objective: To explore the clinical application of heart rate variability(HRV) analysis by Lorenz scatter plot in patients with heart disease. Methods: 170 patients who were diagnosed with heart disease were selected randomly as suspected group from July 2017 to December 2017.According to the final diagnosis, they were divided into heart disease and non heart disease groups.100 healthy subjects were randomly selected as the control group. The dynamic electrocardiogram was carried out and the data were analyzed. The HRV by Lorenz scatter plot, time domain and frequency domain index analyses of the two groups were compared. The diagnostic value of the Lorenz scatter plot, time and frequency domain index analyses were compared. Results: The 170 suspected patients, 136 were diagnosed with heart disease and 34 were not. SDNN, SDANN, L, HF and LF in heart disease group were lower than those in the control group, while D in the heart disease group was higher than that in the control group, the difference was significant(P<0.05).There was no significant difference in the scattered points number of torpedo, spindle and short rod between the heart disease group and the control group(P>0.05). The number of comet like cases in the control group(91.00%) was higher than that in the heart disease group (9.56%) (P<0.05). The number of fan shape(17.65%) and complexity(58.09%) cases in the heart disease group were significantly higher than those in the control group(0%, 4.00%) (P<0.05). The specificity, positive predictive value and accuracy of Lorenz scatter plot were higher than those of time domain and frequency domain index analyses(P<0.05). The kappa value of Lorenz scatter plot and clinical diagnostic criteria was 0.783. The kappa value of time and frequency domain analyses and clinical diagnostic criteria was 0.606.Conclusion: The time domain and frequency domain indexes of patients with heart disease are lower than those of normal persons, and the dispersion of Lorenz scatter plot is increased. The Lorenz scatter plots in patients with heart disease are mainly fan shape and complexity, while the normal people are mainly comet-like. HRV by Lorenz scatter plot has high diagnostic value for patients with heart disease. It can be used as an important means to judge the clinical HRV, which has important clinical value and significance.

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