目的 探讨不同昼夜节律高血压患者心率减速力(DC)改变的临床意义.方法 选择2014年1月～2016年12月在上海交通大学附属第六人民医院(以下简称“我院”)诊治的原发性高血压患者184例,给予动态血压监测,根据其夜间血压下降率结果分为两组:＜10％为非杓型高血压组(NDPH组,118例),≥10％为杓型高血压组(DPH组,66例).选择我院同期健康体检者50名为对照组.应用24 h Holter检测并比较三组入选者的DC、心率加速力(AC)及心率变异性(HRV)水平,并分析其相关性.结果 DPH组及NDPH组DC和正常窦性RR间期的标准差(SDNN)值均明显低于对照组,AC值明显高于对照组(均P＜0.01);NDPH组全程相邻正常R-R间期之差的均方根值(RMSSD)、24 h内差值＞50 ms的连续正常的R-R间期数所占的百分数(PNN50)值也明显低于对照组(P＜0.05).同时与DPH组比较,NDPH组DC、SDNN也明显降低,AC明显增高(P＜0.05).NDPH组患者DC与SDNN、RMSSD呈明显正相关(P＜ 0.01、P＜0.05),与AC呈明显负相关(P＜0.01).结论 不同昼夜节律高血压患者均存在自主神经功能损害,其中NDPH组较DPH组自主神经功能失衡更加明显,在临床工作中不仅要关心高血压患者的血压控制,还应注意其自主神经功能的变化和血压昼夜节律的改变.%Objective To investigate the clinical significance of the changes of deceleration capacity of rate (DC) in patients with primary hypertension of different circadian rhythm.Methods One hundred and eighty-four patients with primary hypertension treated in the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University ("our hospital" for short) from January 2014 to December 2016 were selected and given ambulatory blood pressure monitoring.According to the descent rate of nighttime blood pressure,they were divided into two groups:the patients with descent rate of ＜10％ were taken as non-dipper pattern hypertension group (NDPH group,118 cases),the patients with descent rate of ≥ 10％ were taken as dipper pattern hypertension group (DPH group,66 cases).50 healthy subjects taken physical examination in our hospital at the same time were taken as control group.24 h Holter was used to detect and compare the levels of DC,acceleration capacity of rate (AC),heart rate variability (HRV) among the three groups,and their relevance was analyzed.Results The DC and standard deviation of normal sinus RR intervals (SDNN) in NDPH group and DPH group were significantly lower than that of control group,and AC was significantly higher than that of control group (all P ＜ 0.01);the root mean square of standard deviations of differences between adjacent normal RR intervals (RMSSD) and the proportion derived by dividing NN50 by the total number of NN intervals (PNN50) in NDPH group were significantly lower than that of control group (P ＜ 0.05).DC and SDNN in NDPH group were significantly lower than that of DPH group,and AC was significantly higher than that of DPH group (P ＜ 0.05).In NDPH group,DC was significantly positively correlated with SDNN,RMSSD (P ＜ 0.01,P ＜ 0.05) and negatively correlated with AC (P ＜ 0.01).Conclusion The patients with primary hypertension of different circadian rhythm have impaired autonomic nerve function,and its imbalance in NDPH group is more obvious than that in DPH group.In clinical practice,physicians should not only care for the blood pressure control,but also pay attention to the changes of autonomic function and circadian blood pressure rhythm in the diagnosis and treatment of hypertension.
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