老年高血压患者衰弱与心率变异的相关性研究

Correlation between Frailty and Heart Rate Variability in Elderly Hypertensive Patients

摘要: 背景：衰弱是一种常见的老年综合征，严重影响着老年人的身心健康。高血压是心血管疾病的一个独立危险因素，也是全球心血管死亡的主要原因之一。自主神经系统在血压调节和高血压的发生发展中起着重要作用。目的：探讨住院老年高血压患者衰弱与心率变异的相关性。方法：连续选取2020年10月~2021年9月在石河子大学医学院第一附属医院老年医学科及心内科住院治疗、年龄 ≥ 65岁的高血压患者416例。收集患者的一般资料和动态心电图结果，并评估心率变异性。采用FRAIL量表对患者进行衰弱评估。采用2检验，完全随机设计资料的方差分析探讨住院老年高血压患者心率变异对衰弱的影响。结果：根据FRAIL量表，98例(23.6%)评估为衰弱，196例(47.1%)评估为衰弱前期，122例(29.3%)评估为非衰弱。经2检验，非衰弱组、前衰弱组和衰弱组性别差异有统计学意义(P > 0.05)，经完全随机设计资料的方差分析，非衰弱组、衰弱组和前衰弱组年龄差异有统计学意义(P < 0.05)，进一步行LSD-t两两比较三组间差异均有统计学意义(P < 0.05)。非衰弱组、前衰弱组和衰弱组ISVT差异有统计学意义(P < 0.05)，进一步行LSD-t两两比较非衰弱组和前衰弱组差异无统计学意义(P > 0.05)，非衰弱组和衰弱组、前衰弱组和衰弱组差异均有统计学意义(P < 0.05)。非衰弱组、前衰弱组和衰弱组LVDd、LVPWT差异均无统计学意义(P > 0.05)。非衰弱组、前衰弱组和衰弱组ISVT差异有统计学意义(P < 0.05)，进一步行LSD-t两两比较非衰弱组和前衰弱组差异无统计学意义(P > 0.05)，非衰弱组和衰弱组、前衰弱组和衰弱组差异均有统计学意义(P < 0.05)。非衰弱组、前衰弱组和衰弱组LVDd、LVPWT差异均无统计学意义(P > 0.05)。结论：住院老年高血压患者心率变异性减低可能是导致其衰弱的危险因素，衰弱的发生与年龄增加呈正相关，临床医师在对高血压患者加强衰弱评估的同时，应重视心率变异性的监测。

Abstract: Background: Frailty is a common geriatric syndrome that seriously affects the physical and mental health of older adults. Hypertension is an independent risk factor for cardiovascular disease and one of the leading causes of cardiovascular mortality worldwide. The autonomic nervous system plays an important role in the regulation of blood pressure and the development of hypertension. Objective: To explore the correlation between frailty and heart rate variability in hospitalized elderly patients with hypertension. Methods: Consecutively, 416 hypertensive patients aged ≥65 years who were hospitalized in the Department of Geriatrics and the Department of Cardiology at the First Affiliated Hospital of Shihezi University School of Medicine from October 2020 to September 2021 were selected. General data and ambulatory ECG results of the patients were collected, and heart rate variability was assessed. The patients were assessed for frailty using the FRAIL scale. The effect of heart rate variability on frailty in hospitalized elderly patients with hypertension was explored using the χ2 test and analysis of variance with a completely randomized design data. Results: According to the FRAIL scale, 98 cases (23.6%) were assessed as debilitated, 196 cases (47.1%) were assessed as pre-debilitated, and 122 cases (29.3%) were assessed as non-debilitated. The differences in gender between the non-frail, pre-frail and frail groups were statistically significant (P > 0.05) by 2-test, and the differences in age between the non-frail, frail and pre-frail groups were statistically significant (P < 0.05) by ANOVA with completely randomized design data, and further LSD-t two-by-two comparisons were performed to show statistically significant differences between all three groups (P < 0.05). There was a statistically significant difference in ISVT between the non-debilitated, pre-debilitated and debilitated groups (P < 0.05), and there was no statistically significant difference between the non-debilitated and pre-debilitated groups (P > 0.05) for further two-by-two comparison of LSD-t, and there was a statistically significant difference between the non-debilitated and debilitated groups, and the pre-debilitated and debilitated groups (P < 0.05). The differences of LVDd and LVPWT in the non-debilitated, pre-debilitated and debilitated groups were not statistically significant (P > 0.05). The differences in ISVT between the non-debilitated, pre-debilitated and debilitated groups were statistically significant (P < 0.05), further line LSD-t two-by-two comparison showed no statistically significant differences between the non-debilitated and pre-debilitated groups (P > 0.05), and the differences between the non-debilitated and debilitated groups, pre-debilitated and debilitated groups were statistically significant (P < 0.05). The differences of LVDd and LVPWT in the non-debilitated, pre-debilitated and debilitated groups were not statistically significant (P > 0.05). Conclusion: Decreased heart rate variability in hospitalized elderly hypertensive patients may be a risk factor for their frailty, and the occurrence of frailty is positively correlated with increasing age. Clinicians should pay attention to monitoring heart rate variability while enhancing frailty assessment in hypertensive patients.