中国全科医学 ›› 2025, Vol. 28 ›› Issue (30): 3760-3765.DOI: 10.12114/j.issn.1007-9572.2023.0622

• 论著 • 上一篇    下一篇

收缩压昼夜变异率联合正常RR间期标准差对冠心病诊断价值的临床研究

周启保1, 罗潇1,2,*(), 陈玲1, 曹俊达1, 李菊香2, 徐劲松2, 苏海2   

  1. 1.332000 江西省九江市第一人民医院心血管内科
    2.330000 江西省南昌市,南昌大学第二附属医院心血管内科
  • 收稿日期:2023-11-16 修回日期:2024-06-21 出版日期:2025-10-20 发布日期:2025-08-18
  • 通讯作者: 罗潇

  • 作者贡献:

    周启保、罗潇进行文章的构思与设计以及数据的统计和说明;陈玲、曹俊达、李菊香、徐劲松、苏海进行文献和资料的收集与整理;罗潇、李菊香进行文章的修订;罗潇负责文章的质量控制和审校,并对文章整体负责、监督管理。

  • 基金资助:
    2021年江西省九江市留学人员成果转化项目(JLCB20210501); 九江市科技计划项目(JJSKJJ-2021-ZDYF-14)

Clinical Study on the Diagnostic Value of Circadian Variability of Systolic Blood Pressure Combined with SDNN in Coronary Heart Disease

ZHOU Qibao1, LUO Xiao1,2,*(), CHEN Ling1, CAO Junda1, LI Juxiang2, XU Jinsong2, SU Hai2   

  1. 1. Department of Cardiovascular Medicine, Jiujiang NO.1 People's Hospital, Jiujiang 332000, China
    2. Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
  • Received:2023-11-16 Revised:2024-06-21 Published:2025-10-20 Online:2025-08-18
  • Contact: LUO Xiao

摘要: 背景 目前确诊冠心病的主要方法为冠状动脉增强CT及冠状动脉造影检查,其中冠状动脉增强CT检查由于准确性欠佳,部分患者心率过快不能进行导致其临床应用受限,而作为"金标准"的冠状动脉造影检查由于有创性,在基层医疗单位难以大范围普及同样使其推广受阻。 目的 探索收缩压昼夜变异率联合SDNN对冠心病的诊断价值,以期为评估冠心病诊断提供无创方法学参考。 方法 选取2018—2022年就诊于九江市第一人民医院的246例通过冠状动脉造影检查明确诊断为冠心病且在行冠状动脉造影检查前具有动态心电图检查结果以及病房内昼夜血压监测记录的患者作为研究对象,分为冠心病组与非冠心病组,比较两组对象的一般基线资料;将冠心病诊断与否作为观察终点,分析纳入观察的各项参数与终点事件的相关性并探索可能与终点事件相关的影响因素;绘制收缩压昼夜变异率联合正常窦性心搏间期标准差(SDNN)诊断冠心病的ROC曲线,并进行分析。 结果 冠心病组与非冠心病组基线资料的比较结果显示,年龄、SDNN、收缩压昼夜变异率之间的差异有统计学意义(P<0.05)。相关性分析结果显示,年龄和收缩压昼夜变异率与冠心病诊断呈正相关(P<0.05),左心室舒张末期内径(LVD)和SDNN与冠心病诊断呈负相关(P<0.05)。二元Logistic回归分析显示,年龄、LVD、左心室舒张末容积(EDV)、每分输出量(CO)、SDNN、收缩压昼夜变异率是冠心病诊断的影响因素(P<0.05)。SDNN诊断冠心病的AUC为0.690(95%CI=0.620~0.760),灵敏度和特异度分别为0.753和0.615,对应的最佳截断值为128.5。收缩压昼夜变异率诊断冠心病的AUC为0.908(95%CI=0.869~0.948),灵敏度和特异度分别为0.847和0.896,对应的最佳截断值为14.61%。收缩压昼夜变异率联合SDNN诊断冠心病的AUC为0.914(95%CI=0.875~0.953),灵敏度和特异度分别为0.827和0.917,对应的最佳截断值为0.721。 结论 年龄、LVD、EDV、CO、SDNN、收缩压昼夜变异率是冠心病诊断的影响因素。收缩压昼夜变异率联合SDNN对于冠心病的诊断具有较好的临床应用价值。

关键词: 收缩压昼夜变异率, RR间期标准差, 冠心病, 诊断价值

Abstract:

Background

At present, the main methods for diagnosing coronary heart disease are coronary contrast-enhanced computed tomography and angiography, of which coronary contrast-enhanced computed tomography is limited in clinical application due to its poor accuracy and some patients inability to perform because of rapid heart rate. While coronary angiography, which is the "gold standard", is also hampered in its promotion due to its invasive nature and the difficulty in popularizing in primary care institutions. It is particularly important to use some simple and easily accessible indicators to participate in the diagnosis of coronary heart disease. This study explores the diagnostic value of circadian variability of systolic blood pressure combined with standard deviation of NN intervals (SDNN) in coronary heart disease, with the aim of proposing a simple and practical new predictive method.

Objective

To explore the diagnostic and predictive value of circadian variability of systolic blood pressure combined with SDNN for coronary heart disease, in order to provide non-invasive methodological reference for evaluating and predicting the diagnosis of coronary heart disease.

Methods

From 2018 to 2022, 246 patients who were definitely diagnosed as coronary heart disease by coronary angiography and had Holter monitor examination results and blood pressure monitoring records before coronary angiography were selected as the research objects, and the general baseline data of coronary heart disease and non coronary heart disease were compared. Using the diagnosis of coronary heart disease as the observation endpoint, the correlation between various parameters included in the observation and endpoint events was analyzed, as well as the possible influencing factors related to endpoint events. The predictive value of circadian variability of systolic blood pressure combined with SDNN for the diagnosis of disease was further analyzed.

Results

The baseline data comparison between the coronary heart disease group and non coronary heart disease group showed statistically significant differences in age, SDNN, and circadian variability of systolic blood pressure (P<0.05). Correlation analysis showed that age and circadian variability of systolic blood pressure were positively correlated with the diagnosis of coronary heart disease (P<0.05), left ventricular diastolic dimension (LVD) and SDNN were negatively correlated with the diagnosis of coronary heart disease (P<0.05). Binary Logistic regression analysis showed that age, LVD, end-diastolic volume (EDV), cardiac output (CO), SDNN, and circadian variability of systolic blood pressure were influential factors in the diagnosis of coronary heart disease (P<0.05). The AUC of SDNN for diagnosing coronary heart disease was 0.690 (95%CI=0.620-0.760), with sensitivity and specificity of 0.753 and 0.615, the corresponding optimal cutoff value was 128.5. The AUC of circadian variability of systolic blood pressure for diagnosing coronary heart disease was 0.908 (95%CI=0.869-0.948), with sensitivity and specificity of 0.847 and 0.896, and the corresponding optimal cutoff value was 14.61%. The AUC of circadian variability of systolic blood pressure combined with SDNN for diagnosing coronary heart disease was 0.914 (95%CI=0.875-0.953), with sensitivity and specificity of 0.827 and 0.917, and the corresponding optimal cutoff value was 0.721.

Conclusion

Age, LVD, EDV, CO, SDNN, and the diurnal variation rate of systolic blood pressure are influencing factors for the diagnosis of coronary heart disease. Circadian variability of systolic blood pressure combined with SDNN has good clinical application value in predicting and diagnosing coronary heart disease.

Key words: Circadian variability of systolic blood pressure, Standard deviation of normal to normal, Coronary disease, Diagnostic value

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