The investigation of heart rate variability in uremic patients with respect to metabolic syndrome, diabetes mellitus and high-sensitivity C-reactive protein level

• Main Authors: Shuan-Kuang Jung, 鍾炫光
• Other Authors: Sui-Foon Lo
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/75028617046146245189

碩士 === 中國醫藥大學 === 中西醫結合研究所碩士班 === 97 === Purpose: A decrease in heart rate variability (HRV) is known to be an independent predictor of mortality after myocardial infarction. Metabolic syndrome (MetS), diabetes mellitus(DM) and high-sensitivity C-reactive protein(hs-CRP) level are known to play important roles in cardiovascular morbidity and mortality. Therefore we investigated the heart rate variability (HRV) in uremic patients with respect to metabolic syndrome (MetS)( Asia definition of NCEP-ATP III and IDF), diabetes mellitus(DM) and high-sensitivity C-reactive protein(hs-CRP) level to find out their correlation with cardiovascular risk in these patients. Materials and methods: A cross-sectional cohort study involving 23 patients on maintenance hemodialysis at the Dialysis Unit of The Taipei City Hospital, Yangming Branch. Patients with the following conditions were excluded: <40 years old, >75 years old, hemodialysis history <3 months; presence of cardiac arrhythmia, weak pulses, psychosis, infection or malignance. Each participant took a 20-min rest before the HRV evaluation with ANSWatch ® . The test which last 7 minutes was taken 30 minutes prior to hemodialysis session (pre-dialysis period) and 30 minutes following dialysis session (post-dialysis period). Data in ANSWatch® was downloaded to a notebook computer immediately following the test for review and storage. The blood sample was taken in the same day before hemodialysis. Results: Uremic patients with metabolic syndrome（NCEP-ATPIII）, DM and hs-CRP > 3 have lower HRV when compared to uremic patients without those conditions( 14.88±7.94(n=17)v.s.24.5±4.76(n=6); 13.27±7.48(n=11)v.s.21.17±7.48(n=12);14.54±8.1(n=13)v.s.21.1±7.48(n=10) ) in the pre-dialysis period( all P value < 0.05). We separate the metabolic syndrome（NCEP-ATPIII）to 3 group: The number of risk factors and HRV was found to have negative correlation. Risk factors≦2, risk factors=3 and risk factors≧4 (24.5±4.76(n=6)v.s.17.11±9.45(n=9) v.s.12.38±5.34(n=8)) in the pre-dialysis period and (21±4.38 (n=6) v.s. 17.44±6.21 (n=9) v.s. 11.5±5.24 (n=8)) in the post-dialysis period. Patients with risk factors of metabolic syndrome ≧4 has the lowest HRV. Conclusion: Uremic patients with metabolic syndrome（NCEP-ATPIII）, DM and hs-CRP > 3 have lower HRV which indicating impairment of autonomic nervous function, especially found in the pre-dialysis period. In the metabolic syndrome（NCEP-ATPIII）group, the increase in the risk factors of metabolic syndrome was correlated with the decrease of HRV, indicating the impairment of autonomic nervous function, especially found in the pre-dialysis period. Patients with risk factors of metabolic syndrome≧4 have the highest risk of cardiovascular disease because they have the lowest HRV.