劉孟穎，吳升平，茹小娟，孫冬玲

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·論著·

·慢病管理·

家庭遠(yuǎn)程監(jiān)測(cè)系統(tǒng)下社區(qū)中老年人早晚時(shí)段心率差值及高水平靜息心率的影響因素分析

劉孟穎，吳升平，茹小娟，孫冬玲

目的分析家庭遠(yuǎn)程監(jiān)測(cè)系統(tǒng)下社區(qū)中老年人早晚時(shí)段心率差值及高水平靜息心率的影響因素。方法2013-09-25至2014-01-30，選取北京市石景山區(qū)某社區(qū)符合納入標(biāo)準(zhǔn)且使用家庭遠(yuǎn)程監(jiān)測(cè)系統(tǒng)〔監(jiān)測(cè)06:00～10:00(早晨時(shí)段)、16:00～22:00(晚間時(shí)段)的心率及血壓〕的中老年人78例進(jìn)行研究，居民簽署知情同意書(shū)后統(tǒng)一發(fā)放Lifesense電子血壓儀LS802-4及數(shù)據(jù)基站LS902，囑其在家定時(shí)測(cè)量血壓、心率等，通過(guò)數(shù)據(jù)基站LS902自動(dòng)傳輸?shù)嚼夏耆私】捣?wù)支撐平臺(tái)，共進(jìn)行3個(gè)月的監(jiān)測(cè)。其中早晚時(shí)段心率差值=晚間時(shí)段平均心率-早晨時(shí)段平均心率，并將平均心率≥83次/min定義為高水平靜息心率。收集并記錄所有配合并完成監(jiān)測(cè)的居民的一般資料〔性別、年齡、體質(zhì)指數(shù)(BMI)、散步時(shí)間、吸煙、飲酒〕、用藥史〔是否服用鈣通道阻滯劑(CCB)〕和疾病史(高血壓、高脂血癥、冠心病、糖尿病)。采用多元線性回歸分析中老年人早晚時(shí)段心率差值的影響因素，采用多因素Logistic回歸分析高水平靜息心率的影響因素。結(jié)果服用CCB、患高血壓的中老年人早晚時(shí)段心率差值高于未服用CCB、未患高血壓的中老年人(P<0.05)；不同性別、年齡、BMI及是否吸煙、是否飲酒、是否患高脂血癥、冠心病、糖尿病的中老年人早晚時(shí)段心率差值比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。早晚時(shí)段心率差值影響因素的多元線性回歸分析結(jié)果顯示，早晚時(shí)段心率差值與年齡、BMI、散步時(shí)間、服用CCB、早晨時(shí)段舒張壓有線性回歸關(guān)系(P<0.05)。單因素Logistic回歸分析結(jié)果顯示，吸煙〔OR=3.889,95%CI(1.133,13.354)，P=0.031〕是中老年人早晨時(shí)段出現(xiàn)高水平靜息心率的影響因素；BMI 24～ kg/m2〔OR=4.444,95%CI(1.427,13.839)，P=0.010〕、高脂血癥〔OR=3.018,95%CI(1.117,8.156)，P=0.029〕是中老年人晚間時(shí)段出現(xiàn)高水平靜息心率的影響因素。多因素Logistic回歸分析結(jié)果顯示，吸煙〔OR=3.889,95%CI(1.133,13.354)，P=0.031〕是中老年人出現(xiàn)早晨時(shí)段高水平靜息心率的危險(xiǎn)因素(P<0.05)；晚間時(shí)段舒張壓〔OR=1.593,95%CI(1.023,2.481)，P=0.039〕、高脂血癥〔OR=2.953,95%CI(1.058,8.237)，P=0.039〕是中老年人出現(xiàn)晚間時(shí)段高水平靜息心率的危險(xiǎn)因素。結(jié)論在社區(qū)50歲以上的人群中，早晚時(shí)段心率差值與BMI、散步時(shí)間、服用CCB、早晨時(shí)段舒張壓呈正相關(guān)，與年齡呈負(fù)相關(guān)；吸煙是早晨時(shí)段高水平靜息心率的獨(dú)立影響因素，晚間時(shí)段舒張壓、高脂血癥是晚間時(shí)段高水平靜息心率的獨(dú)立影響因素。

中年人；老年人；社區(qū)網(wǎng)絡(luò)；心率

劉孟穎，吳升平，茹小娟，等.家庭遠(yuǎn)程監(jiān)測(cè)系統(tǒng)下社區(qū)中老年人早晚時(shí)段心率差值及高水平靜息心率的影響因素分析[J].中國(guó)全科醫(yī)學(xué)，2016，19(30)：3729-3735.[www.chinagp.net]

LIU M Y,WU S P,RU X J,et al.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[J].Chinese General Practice，2016，19(30)：3729-3735.

研究發(fā)現(xiàn)，心率與全因死亡和心血管疾病的發(fā)生關(guān)系密切，全因死亡率與心血管疾病病死率均隨心率的升高而遞增，且心率升高對(duì)一般人群病死率或猝死的影響?yīng)毩⒂谄渌ｋU(xiǎn)因素[1-3]。麥勁壯等[4]隊(duì)列研究結(jié)果發(fā)現(xiàn)，心率隨著年齡的增加而明顯升高，且心率≥90次/min的人群全因死亡風(fēng)險(xiǎn)明顯增加。但對(duì)不同心率水平及早晚心率差異影響因素的研究較少，本研究觀察了北京某社區(qū)50歲以上中老年人早晚時(shí)段心率變化，并分析早晚時(shí)段心率差值和高水平靜息心率的影響因素，旨在為有針對(duì)性地控制高水平靜息心率提供幫助。

1　對(duì)象與方法

1.1納入與排除標(biāo)準(zhǔn)納入標(biāo)準(zhǔn)：(1)社區(qū)常住居民(在該社區(qū)至少居住6個(gè)月以上)；(2)年齡>50歲。排除標(biāo)準(zhǔn)：(1)存在心率異常史者；(2)監(jiān)測(cè)期間，服用β-受體阻滯劑類藥物明顯影響心率者；(3)存在甲狀腺相關(guān)疾病病史者；(4)不能堅(jiān)持測(cè)量者；(5)不具備網(wǎng)絡(luò)使用條件者。

1.2研究對(duì)象2013-09-25至2014-01-30，選取北京市石景山區(qū)某社區(qū)符合納入標(biāo)準(zhǔn)且使用家庭遠(yuǎn)程監(jiān)測(cè)系統(tǒng)〔監(jiān)測(cè)06:00～10:00(早晨時(shí)段)、16:00～22:00(晚間時(shí)

段)的心率及血壓〕的中老年人78例進(jìn)行研究，居民均自愿參與本研究并簽署知情同意書(shū)。

1.3家庭遠(yuǎn)程監(jiān)測(cè)系統(tǒng)監(jiān)測(cè)方法居民簽署知情同意書(shū)后統(tǒng)一發(fā)放Lifesense電子血壓儀LS802-4及數(shù)據(jù)基站LS902，囑其在家定時(shí)測(cè)量血壓、心率等，通過(guò)數(shù)據(jù)基站LS902自動(dòng)傳輸?shù)嚼夏耆私】捣?wù)支撐平臺(tái)(www.sechealth.cn)，共進(jìn)行3個(gè)月的監(jiān)測(cè)。早晚時(shí)段心率差值=晚間時(shí)段平均心率-早晨時(shí)段平均心率。根據(jù)心血管疾病中靜息心率的相關(guān)研究[5-6]，本研究將平均心率≥83次/min定義為高水平靜息心率。

1.4監(jiān)測(cè)期間觀察指標(biāo)收集并記錄所有配合并完成監(jiān)測(cè)的居民的一般資料、用藥史和疾病史，其中一般資料包括性別、年齡、體質(zhì)指數(shù)(BMI)、散步時(shí)間、吸煙、飲酒；用藥史即是否服用鈣通道阻滯劑(CCB)；疾病史包括高血壓、高脂血癥、冠心病、糖尿病。其中吸煙定義為≥1支煙/d，持續(xù)12個(gè)月以上；飲酒定義為飲酒≥1次/周。

2　結(jié)果

2.1一般資料、用藥史、疾病史、早晚時(shí)段心率及血壓一般資料：男36例(46.2%)，女42例(53.8%)；平均年齡(59.9±7.1)歲；平均BMI(25.4±3.0)kg/m2；平均散步時(shí)間(1.7±1.3)h/d；吸煙22例(28.2%)；飲酒32例(41.0%)。用藥史：服用CCB34例(43.6%)。疾病史：高血壓45例(57.6%)，高脂血癥25例(32.0%)，冠心病20例(25.6%)，糖尿病17例(21.7%)。早晨時(shí)段心率及血壓：平均心率(76±9)次/min，平均收縮壓(127±12)mmHg(1mmHg=0.133kPa)，平均舒張壓(76±7)mmHg；晚間時(shí)段心率及血壓：平均心率(79±9)次/min，平均收縮壓(126±12)mmHg，平均舒張壓(76±6)mmHg。

2.2早晚時(shí)段心率差值影響因素的單因素分析服用CCB、患高血壓的中老年人早晚時(shí)段心率差值高于未服用CCB、未患高血壓的中老年人，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；不同性別、年齡、BMI及是否吸煙、飲酒、患高脂血癥、患冠心病、患糖尿病中老年人早晚時(shí)段心率差值比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05，見(jiàn)表1)。

2.3早晚時(shí)段心率差值影響因素的多元線性回歸分析將高血壓因素轉(zhuǎn)變?yōu)樵绯繒r(shí)段的血壓值進(jìn)行多元線性回歸分析。以早晚時(shí)段心率差值為因變量，以性別、年齡、BMI、散步時(shí)間、吸煙、飲酒、服用CCB情況、早晨時(shí)段收縮壓及早晨時(shí)段舒張壓、冠心病為自變量(賦值見(jiàn)表2)，進(jìn)行多元線性回歸分析，結(jié)果顯示，早晚時(shí)段心率差值與年齡、BMI、散步時(shí)間、服用CCB、早晨時(shí)段舒張壓有線性回歸關(guān)系(P<0.05，見(jiàn)表3)。

Table1Univariateanalysisofheartratedifferencebetweenmorningandeveningperiodsin78middle-agedandagedpeopleincommunity

項(xiàng)目例數(shù)早晚時(shí)段心率差值t(F)值P值性別1.8010.106 男363.5±5.5 女421.6±4.7年齡(歲)0.648a0.526 50～502.9±5.0 60～202.1±4.6 70～80.8±7.3BMI(kg/m2)2.066a0.134 18.5～311.1±4.7 24～313.0±5.3 28～164.1±5.3吸煙4.7300.735 是222.9±6.4 否562.3±4.6飲酒4.2760.202 是323.4±6.0 否461.8±4.4服用CCB9.3460.002 是344.6±5.9 否440.9±3.9高血壓3.2800.033 是453.5±5.6 否331.0±4.1高脂血癥0.4980.621 是253.0±6.4 否532.3±4.5冠心病0.4830.333 是203.5±5.7 否582.2±4.9糖尿病0.4300.672 是173.1±7.0 否612.3±4.6

注：a為F值；BMI=體質(zhì)指數(shù)，CCB=鈣通道阻滯劑

2.4高水平靜息心率影響因素的單因素Logistic回歸分析以早晨時(shí)段、晚間時(shí)段高水平靜息心率分別為因變量，以性別、年齡、BMI、吸煙、飲酒、服用CCB、高血壓、高脂血癥、冠心病、糖尿病為自變量(賦值見(jiàn)表4)，進(jìn)行單因素Logistic回歸分析，結(jié)果顯示，吸煙是中老年人早晨時(shí)段出現(xiàn)高水平靜息心率的影響因素(P<0.05)；BMI 24～ kg/m2、高脂血癥是中老年人晚間時(shí)段出現(xiàn)高水平靜息心率的影響因素(P<0.05，見(jiàn)表5)。

表2早晚時(shí)段心率差值影響因素的多元線性回歸賦值表

Table 2Assignment of multivariate linear regression analysis on influencing factors for heart rate difference between morning and evening periods

變量賦值早晚時(shí)段心率差值實(shí)測(cè)值性別男=1,女=2年齡(歲)實(shí)測(cè)值/10BMI(kg/m2)實(shí)測(cè)值/4散步時(shí)間(h)實(shí)測(cè)值吸煙否=0,是=1飲酒否=0,是=1服用CCB否=0,是=1早晨時(shí)段收縮壓(mmHg)實(shí)測(cè)值均值/10早晨時(shí)段舒張壓(mmHg)實(shí)測(cè)值均值/5冠心病否=0,是=1

表3早晚時(shí)段心率差值影響因素的多元線性回歸分析

Table 3Multivariate linear regression analysis on influencing factors for heart rate difference between morning and evening periods

影響因素β95%CISEt值P值年齡-1.836(-3.252,-0.419)0.711-2.5830.012BMI1.325(0.079, 2.570)0.6252.1200.037散步時(shí)間0.891(0.118, 1.665)0.3882.2970.025服用CCB2.645(0.535, 4.755)1.0582.4990.015早晨時(shí)段舒張壓0.841(0.109, 1.572)0.3672.2900.025

表4高水平靜息心率影響因素的單因素Logistic回歸分析賦值表

Table 4Assignment of univariate Logistic regression analysis on influencing factors for high-level resting heart rate

變量賦值高水平靜息心率否=0,是=1性別男=1,女=2年齡(歲)50～=1,60～=2,70～=3BMI(kg/m2)18.5～=1,24～=2,28～=3吸煙否=0,是=1飲酒否=0,是=1服用CCB否=0,是=1高血壓否=0,是=1高脂血癥否=0,是=1冠心病否=0,是=1糖尿病否=0,是=1

2.5高水平靜息心率影響因素的多因素Logistic回歸分析以早晨時(shí)段、晚間時(shí)段高水平靜息心率分別為因變量，以性別、年齡、BMI、吸煙、飲酒、服用CCB、高血壓、高脂血癥、冠心病、糖尿病為自變量〔賦值同表4，僅將高血壓因素轉(zhuǎn)變?yōu)樵缤頃r(shí)段血壓實(shí)測(cè)值(賦值：收縮壓實(shí)測(cè)值/10、舒張壓實(shí)測(cè)值/5)進(jìn)行分析〕，進(jìn)行多因素Logistic回歸分析，結(jié)果顯示，吸煙是中老年人出現(xiàn)早晨時(shí)段高水平靜息心率的危險(xiǎn)因素(P<0.05)；晚間時(shí)段舒張壓、高脂血癥是中老年人出現(xiàn)晚間時(shí)段高水平靜息心率的危險(xiǎn)因素(P<0.05，見(jiàn)表6)。

表5高水平靜息心率影響因素的單因素Logistic回歸分析

Table 5Univariate Logistic regression analysis on influencing factors for high-level resting heart rate

影響因素βSEWaldχ2值P值OR值95%CI早晨時(shí)段 吸煙1.3580.6294.6560.0313.889(1.133,13.354)晚間時(shí)段 BMI(kg/m2) 24～1.4920.5806.6250.0104.444(1.427,13.839) 高脂血癥1.1050.5074.7410.0293.018(1.117,8.156)

表6高水平靜息心率影響因素的多因素Logistic回歸分析

Table 6Multivariate Logistic regression analysis on influencing factors for high-level resting heart rate

影響因素βSEWaldχ2值P值OR值95%CI早晨時(shí)段 吸煙1.3580.6294.6560.0313.889(1.133,13.354)晚間時(shí)段 晚間時(shí)段舒張壓0.4660.2264.2490.0391.593(1.023,2.481) 高脂血癥1.0830.5234.2780.0392.953(1.058,8.237)

3　討論

隨著高水平靜息心率與人群全因死亡風(fēng)險(xiǎn)增高相關(guān)的證據(jù)越來(lái)越多[1-6]，了解靜息心率變化的相關(guān)因素及全面了解高水平靜息心率的影響因素十分必要。在靜息心率的相關(guān)研究中，PIWOSKA等[7]研究提到肥胖、低密度脂蛋白(LDL)、血壓、血糖與心率的升高有關(guān)；另一項(xiàng)以企業(yè)職工體檢數(shù)據(jù)為基礎(chǔ)的橫斷面研究表明，健康生活方式(不吸煙、低鹽飲食、經(jīng)常體育鍛煉、BMI<24 kg/m2)有降低靜息心率的作用[8]；以上研究提示靜息心率與一些傳統(tǒng)危險(xiǎn)因素存在相關(guān)性，應(yīng)引起各界的關(guān)注。

本研究結(jié)果顯示，早晚時(shí)段心率差值與年齡、BMI、散步時(shí)間、服用CCB、早晨時(shí)段舒張壓有線性回歸關(guān)系。關(guān)于年齡與早晚時(shí)段心率差值的關(guān)系，一項(xiàng)對(duì)83例25～85歲健康志愿者的心率變異性頻譜分析結(jié)果顯示，隨著志愿者年齡的增加，交感、迷走功能均減弱，生理節(jié)律波動(dòng)下降，從而影響心率[9]。有研究顯示，肥胖人群的迷走神經(jīng)張力降低，交感神經(jīng)活性增加[10]，而超重人群也存在交感神經(jīng)興奮性增高，分析原因與過(guò)多的內(nèi)臟脂肪有關(guān)[11]。本研究結(jié)果顯示，BMI與早晚時(shí)段心率差值呈正相關(guān)，與上述研究結(jié)果相似。本研究結(jié)果顯示，早晚時(shí)段心率差值與散步時(shí)間存在相關(guān)性，原因可能為人體在活動(dòng)中，心率通過(guò)心臟自主神經(jīng)調(diào)節(jié)而逐漸升高，活動(dòng)后的恢復(fù)期心率逐漸接近靜息期[12]，白天活動(dòng)后晚間時(shí)段靜息心率略高于早晨時(shí)段，而經(jīng)過(guò)夜間睡眠后時(shí)恢復(fù)常態(tài)水平。CCB有反射性增加心率的作用，在高水平靜息心率影響因素分析中，服用CCB對(duì)高水平靜息心率無(wú)影響；但從早晚時(shí)段心率差值影響因素的結(jié)果來(lái)看，服用CCB與早晚時(shí)段心率差值呈正相關(guān)，其機(jī)制可能與CCB能反射性升高心率，但不會(huì)影響心率患者上升到高水平(高水平靜息心率患者的心血管事件和死亡風(fēng)險(xiǎn)較高[5-6])有關(guān)。在有關(guān)24 h血壓、心率的研究中，心率在晚間時(shí)段處于低水平，早晨時(shí)段逐漸升高，中午時(shí)段、晚間部分時(shí)段的心率高于早晨時(shí)段上升初期的心率，心率24 h變化大致類似于血壓的杓型狀態(tài)，血壓與心率密切相關(guān)[13-14]。

在高水平靜息心率的影響因素分析中，吸煙者是非吸煙者早晨時(shí)段出現(xiàn)高水平靜息心率的3.889倍。吸煙是一個(gè)經(jīng)典的影響心腦血管疾病的危險(xiǎn)因素，其能導(dǎo)致心率升高[15]。吸煙會(huì)導(dǎo)致機(jī)體產(chǎn)生急性心血管毒性作用，表現(xiàn)為血壓和心率驟升，分析原因?yàn)闊煵葜袩焿A和微量元素鎘含量較高，機(jī)體吸入后可刺激交感神經(jīng)興奮分泌兒茶酚胺[16]。但也有研究顯示，大量吸煙對(duì)交感神經(jīng)有抑制作用，血清兒茶酚胺活性顯著低于正常人[17]。有研究顯示，被動(dòng)吸煙者24 h平均心率及舒張壓均會(huì)升高[18]，本研究對(duì)象部分是夫妻同時(shí)入組，被動(dòng)吸煙者(妻子)的煙草暴露無(wú)法控制，而其產(chǎn)生的危害也應(yīng)引起重視。本研究結(jié)果顯示，高脂血癥患者是非高脂血癥患者晚間時(shí)段出現(xiàn)高水平靜息心率的2.953倍，與相關(guān)研究結(jié)果[19]類似，但其研究對(duì)象為青少年，與本研究對(duì)象(中老年人)年齡類似的研究有待進(jìn)一步檢索。本研究結(jié)果顯示，晚間時(shí)段舒張壓每升高5 mm Hg，其高水平靜息心率的發(fā)生風(fēng)險(xiǎn)增加1.593倍，提示中老年人應(yīng)關(guān)注舒張壓的水平變化。

本研究未發(fā)現(xiàn)樣本人群的高水平靜息心率與年齡、性別有關(guān)，可能與本研究樣本人群的平均年齡為59.9歲，65歲以下的研究對(duì)象占83.3%，年齡間距窄有關(guān)。本研究結(jié)果顯示，冠心病、糖尿病對(duì)高水平靜息心率無(wú)影響，與相關(guān)研究結(jié)果存在一定差異[7-8],原因可能是樣本人群只限于中老年人，且慢性病患者均在積極用藥管理。本研究沒(méi)有檢測(cè)具體的血脂、血糖水平，分析時(shí)僅納入疾病狀態(tài)，未納入實(shí)驗(yàn)室檢查資料，因此結(jié)果可能存在一定的偏倚。但本研究對(duì)象均在一個(gè)社區(qū)，一定程度上能降低氣候環(huán)境因素帶來(lái)的偏倚。

綜上所述，在社區(qū)進(jìn)行50歲以上居民的家庭血壓遠(yuǎn)程監(jiān)測(cè)發(fā)現(xiàn)，早晚時(shí)段心率差值與BMI、散步時(shí)間、服用CCB、早晨時(shí)段舒張壓呈正相關(guān)，與年齡呈負(fù)相關(guān)，且吸煙是早晨時(shí)段出現(xiàn)高水平靜息心率的獨(dú)立危險(xiǎn)因素，高脂血癥、晚間時(shí)段舒張壓是晚間時(shí)段出現(xiàn)高水平靜息心率的獨(dú)立危險(xiǎn)因素。吸煙是可干預(yù)因素，因此在心腦血管病的預(yù)防中，可以通過(guò)嚴(yán)格的戒煙及避免二手煙來(lái)控制較高的心率水平，同時(shí)再次證實(shí)了降脂、控制體質(zhì)量、降壓對(duì)控制靜息心率的重要性。

作者貢獻(xiàn)：孫冬玲進(jìn)行試驗(yàn)設(shè)計(jì)與實(shí)施、質(zhì)量控制及校審，劉孟穎負(fù)責(zé)資料收集整理、撰寫(xiě)論文、成文并對(duì)文章負(fù)責(zé)；吳升平、茹小娟進(jìn)行試驗(yàn)實(shí)施、評(píng)估。

本文無(wú)利益沖突。

[1]GILLMAN M W,KANNEL W B,BELANGER A,et al.Influence of heart rate on mortality among persons with hypertension:the Framingham Study[J].Am Heart J,1993,125(4):1148-1154.

[2]GREENLAND P,DAVIGLUS M L,DYER A R,et al.Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality:the Chicago Heart Association Detection Project in Industry[J].Am J Epidemiol,1999,149(9):853-862.

[3]SECCARECCIA F,PANNOZZO F,DIMA F,et al.Heart rate as a predictor of mortality:the MATISS project [J].Am J Public,2001,91(8):1258-1263.

[4]麥勁壯,趙連成,劉小清,等.心率與全因死亡及冠心病事件關(guān)系的隊(duì)列人群研究[J].中華心血管病雜志,2009,37(8):750-753.

MAI J Z，ZHAO L C，LIU X Q，et al.Association between heart rate and all-cause death and coronary event in the Chinese cohort:16 years follow up results[J].Chinese Journal of Cardiology，2009,37(8):750-753.

[5]FOX K,BORER J S,CAMM A J,et al.Resting heart rate in cardiovascular disease[J].J Am Coll Cardiol,2007,50(9):823-830.

[6]DIAZ A,BOURASSA M G,GUERTIN M C,et al.Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease[J].Eur Heart J,2005,26(10):967-974.

[8]高競(jìng)生,梁欣,施繼紅,等.理想心血管健康行為和因素對(duì)靜息心率的影響[J].中華心血管病雜志，2014，42(9):778-783.

GAO J S，LIANG X，SHI J H，et al.Impact of ideal cardiovascular health behaviors and factors on resting heart rate in individuals without cardiovascular diseases[J].Chinese Journal of Cardiology，2014，42( 9 ):778-783.

[9]PICCIRILLO G,FIMOGNARI F L,VIOLA E,et al.Age-adjusted normal confidence intervals for heart rate variability in healthy subjects during head-up tilt[J].Int J Cardiol,1995,50(2):117-124.

[10]KARASON K,M?LGAARD H,WIKSTRAND J,et al.Heart rate variability in obesity and the effect of weight loss[J].Am J Cardiol,1999,83(8):1242-1247.

[11]CHINTALA K K,KRISHNA B H,N M R.Heart rate variability in overweight health care students:correlation with visceral fat[J].J Clin Diagn Res，2015，9(1):CC06-08.

[12]ARAI Y,SAUL J P,ALBRECHT P,et al.Modulation of cardiac autonomic activity during and immediately after exercise[J].Am J Physiol,1989,256(1):H132-141.

[13]DEGAUTE J P,VAN DE BORNE P,LINKOWSKI P,et al.Quantitative analysis of the 24-hour blood pressure and heart rate patterns in young men[J].Hypertension,1991,18(2):199-210.

[14]KOROBOKI E，MANIOS E，PSALTOPOULOU T，et al.Circadian variation of blood pressure and heart rate in normotensives,white-coat,masked,treated and untreated hypertensives[J].Hellenic Journal of Cardiology，2012，53(6):432-438.

[15]AL-SAFI S A.Does smoking affect blood pressure and heart rate?[J].Eur J Cardiovasc Nurs,2005,4(4):286-289.

[16]楊春.吸煙對(duì)血壓心率心電圖即刻效應(yīng)的研究[J].環(huán)境與健康雜志,2003,20(6):347-348.

YANG C.Study on the Immediate effects of smoking on blood pressure,heart rate and electrocardiogram in smokers[J].Journal of Environment and Health,2003,20(6):347-348.

[17]葉康平.吸煙對(duì)人血清多巴胺-β-羥化酶活性雙相影響[J].國(guó)外醫(yī)學(xué)衛(wèi)生學(xué)分冊(cè),1993(2):27.

[18]趙菁,何飛,胡大一，等.被動(dòng)吸煙人群特征及對(duì)心率變異性、心率和血壓的影響[J].中華心血管病雜志,2013,41(5):422-426.

ZHAO J，HE F，HU D Y，et al.Population characteristics and impact on heart rate variability,heart rate and blood pressure of passive smoking[J].Chinese Journal of Cardiology,2013,41(5):422-426.

[19]FREITAS JúNIOR I F,MONTEIRO P A,SILVEIRA L S,et al.Resting heart rate as a predictor of metabolic dysfunctions in obese children and adolescents[J].BMC Pediatrics,2012,12(1):5.

(本文編輯：毛亞敏)

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

LIUMeng-ying,WUSheng-ping,RUXiao-juan,SUNDong-ling.

BeijingNeurosurgicalInstitute;BeijingTianTanHospital,CapitalMedicalUniversity;BeijingMunicipalKeyLaboratoryofClinicalEpidemiology,Beijing100050,China

Correspondingauthor:SUNDong-ling,BeijingNeurosurgicalInstitute;BeijingTianTanHosipital,CapitalMedicalUniversity;BeijingMunicipalKeyLaboratoryofClinicalEpidemiology,Beijing100050,China;E-mail:sdongling@sina.com

ObjectiveTo 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.MethodsAccording 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.ResultsHeart 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.ConclusionAmong 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.

Middle-aged people;Aged people;Community networks;Heart rate

國(guó)家科技支撐計(jì)劃課題(2012BAH06F06)；十二五科技支撐計(jì)劃項(xiàng)目(2011BAI08B01)；北京市神經(jīng)外科研究所2014年度青年創(chuàng)新基金(計(jì)劃)(所青年-2014006)

100050北京市，北京市神經(jīng)外科研究所，首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院，臨床流行病學(xué)北京市重點(diǎn)實(shí)驗(yàn)室

孫冬玲，100050北京市，北京市神經(jīng)外科研究所，首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院，臨床流行病學(xué)北京市重點(diǎn)實(shí)驗(yàn)室；E-mail:sdongling@sina.com

R 331.31

A

10.3969/j.issn.1007-9572.2016.30.019

2016-03-13；

2016-08-06)