摘要
目的:探讨心率昼夜节律紊乱预测慢性肾脏病(chronic kidney disease,CKD)5期患者全因死亡的价值。方法:本研究为回顾性队列研究,纳入2011年2月至2019年12月在南京医科大学第一附属医院和南京医科大学附属明基医院就诊的CKD 5期患者为研究对象,同期入选159名健康志愿者设为健康对照组。采用24 h动态心电图监测入选者24 h心率,并计算心率昼夜节律指标(包括24 h心率、白天及夜间平均心率、夜/昼心率比值、24 h最大心率、24 h最小心率以及24 h心率极差)。夜/昼心率比值>0.9定义为"非勺型心率"。采用多因素Cox回归法分析CKD 5期患者全因死亡的危险因素;Kaplan-Meier生存曲线及Log-rank检验比较夜/昼心率比值>0.91(高比值)组和≤0.91(低比值)组患者累积死亡率的差异;限制性立方样条图法分析夜/昼心率比值和全因死亡率之间的非线性关系;时间依赖的ROC曲线分析夜/昼心率比值对CKD 5期患者全因死亡的预测价值。结果:共159名健康志愿者和221例CKD 5期患者入选本研究,CKD 5期患者男性123例(55.66%),年龄(52.72±13.13)岁。中位随访时间为50.0个月。与健康对照组相比,CKD 5期患者24 h、夜间平均心率以及24 h最小心率均升高;夜/昼心率比值上升[(0.91±0.09)比(0.81±0.08),P<0.001],呈"非勺型心率"状态;24 h最大心率和24 h心率极差降低(均P<0.05)。多因素Cox回归分析结果显示,夜/昼心率比值增高(每增加0.1,HR=1.557,95%CI 1.073~2.258,P=0.020)是患者全因死亡的独立影响因素。Kaplan-Meier生存曲线分析结果显示,夜/昼心率高比值组患者的累积死亡率高于低比值组(Log-rank检验χ^(2)=7.232,P=0.007)。限制性立方样条图结果显示,CKD 5期患者夜/昼心率比值与全因死亡率之间呈线性效应关系(P=0.141),当夜/昼心率比值>0.91时,CKD 5期患者的全因死亡风险显著增加。时间依赖的ROC曲线表明,在随访时间长达70.0个月时,夜/昼心率比值预�
Objective To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease(CKD 5)patients.Methods The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)and the Affiliated BenQ Hospital of Nanjing Medical University from February,2011 to December,2019.A total of 159 healthy volunteers were enrolled as the healthy control group during the same period.The circadian rhythm of heart rate was monitored by 24-hour Holter.Related indices(including 24-hour,daytime and nighttime mean heart rate,night/day heart rate ratio,24-hour maximum heart rate,24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate)were calculated.Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9.Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients.Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group(night/day heart rate ratio>0.91)and low ratio group(night/day heart rate ratio≤0.91).The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot.Time-dependent receiver operating characteristic(ROC)curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients.Results A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study.There were 123 males(55.66%)and the age was(52.72±13.13)years old in CKD 5 patients.The total median follow-up time was 50.0 months.Compared with controls,24-hour,nighttime mean heart rate,24-hour minimum heart rate in CKD 5 patients were increased(all P<0.05),furthermore,the night/day heart rate ratio was higher[(0.91±0.09)vs(0.81±0.08),P<0.001],showing"non-dipping heart rate".However,the 24-hour maximum heart rate and th
作者
任文凯
崔颖
曾鸣
黄慧
唐少文
杨光
黄耀禹
高占辉
徐方燕
钱寒阳
王静
欧阳春
高雪艳
葛益飞
肖雨洁
邢昌赢
魏永越
王宁宁
Ren Wenkai;Cui Ying;Zeng Ming;Huang Hui;Tang Shaowen;Yang Guang;Huang Yaoyu;Gao Zhanhui;Xu Fangyan;Qian Hanyang;Wang Jing;Ouyang Chun;Gao Xueyan;Ge Yifei;Xiao Yujie;Xing Changying;Wei Yongyue;Wang Ningning(Department of Nephrology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China;Department of Epidemiology and Biostatistics,School of Public Health,Nanjing Medical University,Nanjing 211166,China;Department of Nephrology,BenQ Medical Center,the Affiliated BenQ Hospital of Nanjing Medical University,Nanjing 210019,China;Department of Nephrology,Liyang Branch,Jiangsu Province Hospital,Liyang People's Hospital,Liyang 213300,China;Department of General Medicine,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China;China International Cooperation Center for Environment and Human Health,Nanjing Medical University,Nanjing 211166,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2021年第7期558-566,共9页
Chinese Journal of Nephrology
基金
国家自然科学基金(81270408,81570666)
国际肾脏病学会临床研究项目(18-01-0247)
江苏省临床医学研究中心支撑体系建设项目(BL2014084)
江苏省"医学重点人才"项目(ZDRCA2016002,RC201162)
中华国际医学交流基金会肾性贫血科研基金(Z-2017-24-2037)。
关键词
肾功能衰竭
慢性
心率
昼夜节律
全因死亡率
非勺型心率
Kidney failure,chronic
Heart rate
Circadian rhythm
All-cause mortality
Non-dipping heart rate
