不同证型胸痹心痛患者的心理状态与心率变异性特征分析*

作者：何 佳，程晓昱，朱振鹏，姚淮芳

单位：安徽中医药大学第一附属医院，安徽 合肥 230000

引用：引用：何佳，程晓昱，朱振鹏，姚淮芳.不同证型胸痹心痛患者的心理状态与心率变异性特征分析[J].中医药导报,2026,32(5):99-104.

DOI：10.13862/j.cn43-1446/r.2026.05.016

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摘要：

目的：分析不同证型胸痹心痛患者心理状态、心率变异性（HRV）变化及临床意义。方法：选取240例胸痹心痛患者，依据中医辨证分为肝郁气滞证（22例）、气虚血瘀证（62例）、气滞血瘀证（68例）及痰瘀互结证（88例）。比较各证型患者基线资料、HRV指标（时域及频域）、心率极值指标、心理状态量表评分[压力知觉问卷（CPSS-14）、广泛性焦虑障碍量表（GAD-7）、抑郁症筛查量表（PHQ-9）和阿森斯失眠量表（AIS）]及血清脂蛋白（a）[Lp(a)]、同型半胱氨酸（Hcy）水平。结果：气虚血瘀证患者平均年龄最高，痰瘀互结证患者冠心病占比最高（80.68%）。HRV指标中，气虚血瘀证患者24 h R-R间期标准差（SDNN）、24 h相邻R-R间期差值的均方根（rMSSD）、相邻的R-R间期之差＞50 ms的个数占总的R-R间期个数的百分比（pNN50）均高于其他证型（P＜0.05）；气滞血瘀证患者24 h每5 min R-R间期平均值的标准差（SDANN）低于其他证型（P＜0.05）；肝郁气滞证患者每5 min R-R间期标准差平均值（ASDNN）、相邻的R-R间期之差＞50 ms的个数占总的R-R间期个数的百分比（pNN50）均低于其他证型（P＜0.05）；气虚血瘀证低、高频功率均高于其他证型（P＜0.05）；肝郁气滞证低频、总功率低于其他证型（P＜0.05），而最慢心率和最快心率高于其他证型（P＜0.05）。心理状态方面，气滞血瘀证患者CPSS-14评分最高，痰瘀互结证GAD-7、PHQ-9及AIS评分最高（P＜0.05）。血清指标方面，痰瘀互结证患者Lp（a）水平最高，肝郁气滞证患者Hcy水平最高（P＜0.05）。结论：胸痹心痛不同证型在年龄、冠心病患病比例、心理状态、HPV、Lp（a）及Hcy水平上存在特异性差异，可为临床个体化辨证诊疗提供参考。

关键词：胸痹心痛；冠心病；中医证型；心理状态；心率变异性

Abstract：

Objective: To analyze the characteristics and clinical significance of psychological status and heart rate variability (HRV) in patients with chest stuffiness and pain of different TCM syndromes. Methods: A total of 240 patients were divided into four syndrome groups: liver-depression qi stagnation (22 cases), qi-deficiency blood stasis (62 cases), qi-stagnation blood stasis (68 cases), and phlegm-blood stasis syndrome (88 cases). Baseline data, HRV indicators (time domain and frequency domain), extreme heart rate indicators, psychological state scale scores (CPSS-14, GAD-7, PHQ-9, and AIS), and serum levels of lipoprotein (a) [Lp(a)] and homocysteine (Hcy) were compared among the four groups. Results: Patients with qi-deficiency blood stasis syndrome had the highest average age, and the proportion of coronary heart disease was the highest in patients with phlegm-blood stasis syndrome (80.68%). In terms of HRV indicators, SDNN, rMSSD, and pNN50 in qi-deficiency blood stasis syndrome were higher than those in the other syndromes (P<0.05); SDANN in qi-stagnation blood stasis syndrome was lower than that in other syndromes (P<0.05); ASDNN and pNN50 in liver-depression qi stagnation syndrome were lower than those in other syndromes (P<0.05); both low-frequency power and high-frequency power in qi-deficiency blood stasis syndrome were higher than those in other syndromes (P<0.05); low-frequency power and total power in liver-depression qi stagnation syndrome were lower than those in other syndromes (P<0.05), while the slowest and fastest heart rates were higher than those in other syndromes (P<0.05); high-frequency power in phlegm-blood stasis syndrome was lower than that in other syndromes (P<0.05). In terms of psychological state, the CPSS-14 score was the highest in qi-stagnation blood stasis syndrome, and the scores of GAD-7, PHQ-9, and AIS were the highest in phlegm-blood stasis syndrome (P<0.05). In terms of serum indicators, Lp(a) level was the highest in phlegm-blood stasis syndrome, and Hcy level was the highest in liver-depression qi stagnation syndrome (P<0.05). Conclusion: Patients with different TCM syndromes of chest stuffiness and pain show distinct differences in age, proportion of coronary heart disease, psychological status, HRV, Lp(a) and Hcy levels, providing a reference for individualized syndrome-based diagnosis and treatment.

Key words：chest stuffiness and pain; coronary heart diseaes; TCM syndrome; psychological state; heart rate variability

发布时间：2026-05-23

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