目的探讨心率变异性(heart rate variability,HRV)与冠状动脉病变范围和程度的关系.方法回顾性分析我院冠心病患者186例的冠状动脉病变范围程度和HRV指标.用Logistic回归筛选冠状动脉病变的HRV预测指标.结果HRV时域指标和频域指标均随冠状动脉病变范围和程度的加重而降低,时域指标,包括正常窦性心搏间期标准差(standard deviation of normal number of intervals,SDNN),每5分钟平均正常窦性心搏间期标准差(standard deviation of per 5 min averages normal number of intervals,SDANN),正常窦性心搏间期标准差平均值(average of standard deviation of normal number of intervals,ASDNN),相邻正常窦性心搏间期差的平方根值(root mean square values of the standard deviationbetween adjacent normal number of intervals,rMSSD),相邻正常窦性心搏间期差超过50 ms的个数占总窦性心搏数的百分率(percentage of differences exceeding 50 ms between adjacent normal number of intervals PNN50),PNN50包括PNN50a(大于相邻心搏间期50 ms)和PNN50b(小于相邻心搏间期50ms),频域指标包括低频带(low frequency,LF),极低频带(very low frequency,VLF),高频带(highfrequency,HF)都与冠状动脉病变范围和程度呈负相关(P<0.01或P<0.05);Logistic回归结果表明SDANN、LF/HF为冠状动脉病变范围和程度的保护因素.结论有冠状动脉病变的患者HRV降低,存在自主神经功能紊乱;HRV与冠状动脉病变范围和程度呈负相关.