中国全科医学2025，Vol.28Issue(30)：3760-3765,6.DOI:10.12114/j.issn.1007-9572.2023.0622
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
Clinical Study on the Diagnostic Value of Circadian Variability of Systolic Blood Pressure Combined with SDNN in Coronary Heart Disease
摘要
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.关键词
收缩压昼夜变异率/RR间期标准差/冠心病/诊断价值Key words
Circadian variability of systolic blood pressure/Standard deviation of normal to normal/Coronary disease/Diagnostic value分类
医药卫生引用本文复制引用
周启保,罗潇,陈玲,曹俊达,李菊香,徐劲松,苏海..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[J].中国全科医学,2025,28(30):3760-3765,6.基金项目
2021年江西省九江市留学人员成果转化项目(JLCB20210501) （JLCB20210501）
九江市科技计划项目(JJSKJJ-2021-ZDYF-14) （JJSKJJ-2021-ZDYF-14）
