Abstract: Objective　To analyze influencing factors of heart rate difference and high-level resting heart rate between morning and evening periods among the middle-aged and aged people in community under home telemonitoring system.Methods　According to inclusion criteria,78 middle-aged and aged people from a community in Shijingshan district of Beijing,who were using home telemonitoring system 〔including heart rate and blood pressure from 06:00-10:00 at a.m.（morning periods） and 16:00-22:00 p.m.（evening periods）〕,were selected from September 25th in 2013 to January 30th in 2014.After the residents signing informed consent form,Lifesense electronic blood pressure meter LS802-4 and data base station LS902 were unified distributed.They were warned to measure their blood pressure and heart rate when at home.The data would automatically transmit to health service support platform of the elderly through the data base station LS902.Three-month monitoring was conducted totally.Heart rate difference between morning and evening periods= average heart rate during evening periods-average heart rate during morning periods,and the average heart rate greater than or equal to 83 times/min was defined as resting heart rate of high level.The general data 〔gender,age,body mass index （BMI）,strolling time,smoking,drinking〕,medication history 〔whether taking calcium channel blockers （CCB） or not〕 and diseases history （hypertension,hyperlipidemia,coronary heart disease,diabetes） of residents who cooperated in the investigation and completed the monitoring were collected and recorded.The influencing factors of heart rate difference between morning and evening periods were analyzed by multivariate linear regression analysis and the influencing factors of resting heart rate of high level were analyzed by multiple Logistic regression analysis.Results　Heart rate difference between morning and evening periods of middle-aged and aged people who had hypertension and took CCB was higher than that of middle-aged and aged people who did not have hypertension and take CCB （P<0.05）;there was no significant difference in heart rate difference between morning and evening periods among middle-aged and aged people of different genders,ages,BMI,and whether smoking,drinking,whether developing hyperlipemia,coronary heart disease and diabetes （P>0.05）.The results of multiple linear regression analysis of the influencing factors of heart rate difference between morning and evening periods showed that there was a linear regression relationship between heart rate difference between morning and evening periods and age,BMI,strolling time,taking CCB as well as diastolic blood pressure during morning periods （P<0.05）.The results of univariate Logistic regression analysis showed that smoking 〔OR=3.889,95%CI （1.133,13.354）,P=0.031〕 was the influencing factor of high-level resting heart rate occurring in middle-aged and aged people during morning periods;BMI 24~ kg/m2〔OR=4.444,95%CI （1.427,13.839）,P=0.010〕,and hyperlipidemia 〔OR=3.018,95% CI （1.117,8.156）,P=0.029〕 were the influencing factors of high-level resting heart rate occurring in middle-aged and aged people during evening periods.The results of multivariate regression analysis showed that smoking 〔OR=3.889,95%CI （1.133,13.354）,P=0.031〕 was the influencing factor of high-level resting heart rate occurring in middle-aged and aged people during morning periods;diastolic blood pressure 〔OR=1.593,95%CI （1.023,2.481）,P=0.039〕 and hyperlipidemia 〔OR=2.953,95%CI （1.058,8.237）,P=0.039〕 were the influencing factors of high-level resting heart rate occurring in middle-aged and aged people during evening periods.Conclusion　Among the elderly aged over 50,heart rate difference between morning and evening periods is positively associated with BMI,strolling time,took CCB and diastolic blood pressure during morning periods,and was negatively related with age;smoking is the independent influencing factors of high-level resting heart rate in morning periods.Diastolic blood pressure and hyperlipidemia are the independent influencing factors of high-level resting heart rate in evening periods.

Key words: Middle-aged people, Aged people, Community networks, Heart rate

摘要： 目的　分析家庭远程监测系统下社区中老年人早晚时段心率差值及高水平静息心率的影响因素。方法　2013-09-25至2014-01-30，选取北京市石景山区某社区符合纳入标准且使用家庭远程监测系统〔监测06:00～10:00（早晨时段）、16:00～22:00（晚间时段）的心率及血压〕的中老年人78例进行研究，居民签署知情同意书后统一发放Lifesense电子血压仪LS802-4及数据基站LS902，嘱其在家定时测量血压、心率等，通过数据基站LS902自动传输到老年人健康服务支撑平台，共进行3个月的监测。其中早晚时段心率差值=晚间时段平均心率-早晨时段平均心率，并将平均心率≥83次/min定义为高水平静息心率。收集并记录所有配合并完成监测的居民的一般资料〔性别、年龄、体质指数（BMI）、散步时间、吸烟、饮酒〕、用药史〔是否服用钙通道阻滞剂（CCB）〕和疾病史（高血压、高脂血症、冠心病、糖尿病）。采用多元线性回归分析中老年人早晚时段心率差值的影响因素，采用多因素Logistic回归分析高水平静息心率的影响因素。结果　服用CCB、患高血压的中老年人早晚时段心率差值高于未服用CCB、未患高血压的中老年人（P<0.05）；不同性别、年龄、BMI及是否吸烟、是否饮酒、是否患高脂血症、冠心病、糖尿病的中老年人早晚时段心率差值比较，差异均无统计学意义（P>0.05）。早晚时段心率差值影响因素的多元线性回归分析结果显示，早晚时段心率差值与年龄、BMI、散步时间、服用CCB、早晨时段舒张压有线性回归关系（P<0.05）。单因素Logistic回归分析结果显示，吸烟〔OR=3.889,95%CI（1.133,13.354），P=0.031〕是中老年人早晨时段出现高水平静息心率的影响因素；BMI 24～ kg/m2〔OR=4.444,95%CI（1.427,13.839），P=0.010〕、高脂血症〔OR=3.018,95%CI（1.117,8.156），P=0.029〕是中老年人晚间时段出现高水平静息心率的影响因素。多因素Logistic回归分析结果显示，吸烟〔OR=3.889,95%CI（1.133,13.354），P=0.031〕是中老年人出现早晨时段高水平静息心率的危险因素（P<0.05）；晚间时段舒张压〔OR=1.593,95%CI（1.023,2.481），P=0.039〕、高脂血症〔OR=2.953,95%CI（1.058,8.237），P=0.039〕是中老年人出现晚间时段高水平静息心率的危险因素。结论　在社区50岁以上的人群中，早晚时段心率差值与BMI、散步时间、服用CCB、早晨时段舒张压呈正相关，与年龄呈负相关；吸烟是早晨时段高水平静息心率的独立影响因素，晚间时段舒张压、高脂血症是晚间时段高水平静息心率的独立影响因素。

关键词: 中年人, 老年人, 社区网络, 心率