Clinical Study On Heart Rate Variability And TCM Constitution In Patients With Coronary Heart Disease And Paroxysmal Atrial Fibrillatio

This study consists of literature review and clinical research.Literature review:In summary 1,The first review mainly discusses the epidemiology and development trend of coronary heart disease(CHD)and atrial fibrillation(PAF).Coronary heart disease can lead to the occurrence of atrial fibrillation.For patients with coronary heart disease and atrial fibrillation,the short-term and long-term mortality and the occurrence of major cardiovascular events are significantly increased.Autonomic nerve function is one of the mechanisms of atrial fibrillation and coronary heart disease.Heart rate variability is an index to evaluate the damage of autonomic nerve function.It has been found that there is a decrease of heart rate variability in the process of occurrence and development of coronary heart disease and atrial fibrillation.However,at present,the mechanism of atrial fibrillation in patients with coronary heart disease is mostly studied from the aspects of inflammation,atrial traction,hormone activation,etc,which has not been studied through HRV explained that autonomic nervous function may also participate in the process of atrial fibrillation in coronary heart disease.In summary 2,it is argued that at present,there is a general consensus on the etiology and pathogenesis of coronary heart disease in TCM,and there are many researches on the correlation between coronary heart disease and TCM constitution theory.It is found that most of the constitution types of patients with coronary heart disease are Qi deficiency,phlegm dampness and blood stasis.It is also found that the constitution types of patients with coronary heart disease,heart rate variability and Autonomic nervous function are related.However,at present,there are few researches on the constitution type of Chinese medicine of atrial fibrillation,and there are no researches on paroxysmal atrial fibrillation and constitution and coronary heart disease with paroxysmal atrial fibrillation.Therefore,in the future,we can explore more researches on the constitution type of Chinese medicine of coronary heart disease with paroxysmal atrial fibrillation,so as to provide new ideas for the prevention and diagnosis and treatment of this part of patients.Clinical Research:Objective:The purpose of this study is to explore the relationship between coronary heart disease patients with paroxysmal atrial fibrillation and autonomic nerve function,and the characteristics of TCM Constitution distribution.Methods:From January 2018 to January 2020,140 patients with coronary heart disease were selected,including 70 patients with coronary heart disease and paroxysmal atrial fibrillation as the study group and 70 patients with coronary sinus rhythm as the control group.All patients were collected general data,measured the relevant test indicators,performed 24-hour ECG and coronary angiography,and evaluated the constitution of coronary heart disease patients with paroxysmal atrial fibrillation.Result:1.General condition:The age of CHD with PAF group was older than that of CHD with sinus rhythm group(P<0.05),the difference was statistically significant.The history of dyslipidemia between the two groups(P<0.05),with statistical differences.2.Biochemical index:Compared with simple CHD with sinus rhythm group,CRP was higher(P<0.05),TC and LDL-C were higher(P<0.05)in CHD combined with PAF group,and the difference was statistically significant.3.HRV index:Compared with CHD with sinus rhythm group group,SDNN,SDANN,SDNNA,RMSSD,pNN50 indexes(P<0.05)of CHD combined with PAF group were significantly lower,among which SDNN-24h,SDANN,SDNNI,RMSSD indexes were statistically different between the two groups,while pNN50 indexes were not statistically different.4.TCM Constitution distribution:Phlegm-dampness constitution 17 cases(24.29%),Yin-deficiency constitution 15 cases(21.43%),Blood-stasis constitution 13 cases(18.57%),Qi-deficiency constitution 10 cases(14.29%),Yang-deficiency constitution 7 cases(10.00%),damp-heat constitution 3 cases(4.29%),Qi-stagnation constitution 4 cases(5.71%),normal constitution 1 case(1.43%)and special intrinsic constitution 0 case(0.00%).Among them,Phlegm-dampness constitution,Yin-deficiency,Blood-stasis constitution and Qi-deficiency constitution are the most,while the Other constitution are less.In the aspect of blood lipid,the total TC level and LDL-C of Phlegm-dampness constitution group were higher than those of Yin-deficiency constitution group,Blood-stasis constitution group,Qi-deficiency constitution group and other constitution groups,and there were statistical differences between the five groups(P<0.05).At the time domain index SDNN-24h level,Phlegm-dampness constitution group,Yin-deficiency constitution group,Qi-deficiency constitution group were lower than blood-stasis constitution group and other constitution groups.The difference was statistically significant(P<0.05),but SDNNI,SDANN,RMMSD and pNN50 were not statistically significant(P<0.05).The level of pNN50 in the phlegm-dampness group was lower than that in the non phlegm dampness group,with statistical difference(P<0.05).5.Regression Analysis:Multivariate logistic regression analysis showed that age(or=1.093,95%CI:1.006-1.188,P=0.037),TC(or=4.125,95%CI:1.653-10.293,P=0.002),hs-CRP(or=2.304,95%CI:1.433-3.705,P=0.001)were the independent risk factor of coronary heart with paroxysmal atria lfibrillaltion disease,SDANN(OR=0.934,95%CI:0.987-0.973,P=0.001),SDNNI(OR=0.916,95%CI:0.852-0.983,P=0.016).Conclusions:The SDNN-24h,SDANN,SDNNI and RMSSD of CHD with PAF group were significantly lower than CHD with sinus rhythm group.Phlegm-dampness constitution,Yin-deficiency,Blood-stasis constitution and Qi-deficiency constitution are the most,while the Other constitution are less;TC level and LDL-C level of phlegm-dampness group were higher than Yin-deficiency group,blood-stasis group,Qi-deficiency group and other constitution groups.At the time domain index SDNN-24h level,Phlegm-dampness constitution group,Yin-deficiency constitution group,Qi-deficiency constitution group were lower than blood-stasis constitution groupand other constitution groups,the difference was statistically significant(P<0.05),but SDNNI,SDANN,RMMSD and pNN50 were not statistically significant(P<0.05).The level of pNN50 in the phlegm-dampness group was lower than that in the non phlegm dampness group,with statistical difference(P<0.05).Multivariate logistic regression analysis showed that age,TC,hs-CRP were the independent risk factor of coronary heart disease with paroxysmal atrial fibrillation,SDANN,SDNNI.