高血压合并急性脑血管病的心率变异分析

目的：探讨急性脑组织损害对原发性高血压（ＥＨ）患者心率变异（ＨＲＶ）的影响。方法：对２６例ＥＨ并急性脑血管病（ＡＣＶＤ）患者进行２４ｈ动态心电图ＨＲＶ测定,并与２０例ＥＨ元ＡＣＶＤ患者进行对比。结果：ＥＨ并ＡＣＶＤ组最小心率及平均心率明显高于无ＡＣＶＤ组（Ｐ〈０．０１;Ｐ〈０．０１）;２４ｈ相邻Ｒ－Ｒ间期之差的均方根（ｒＭＳＳＤ）、相邻Ｒ－Ｒ间期之差大于５０ｍｓ的心搏数占心搏总数的百分比（ＰＮＮ５     

复发性抑郁症与长期住院精神分裂症患者的心率变异性差异

目的 比较复发性抑郁症与长期住院精神分裂症患者之间心率变异性（HRV）的差异。 方法 回顾性连续纳入2014 年1 月至2019 年1 月于上海交通大学医学院附属精神卫生中心精神科住 院治疗的多次发作的抑郁症或长期住院精神分裂症患者各120 例,两组患者性别、年龄相匹配。对两 组患者分别开展HRV 检测,使用24 h 动态心电图记录仪和心率变异分析软件进行检测,并对HRV相关 指标R-R间期标准差（ SDNN）、相邻R-R间期差值的均方根（ rMSSD）、相邻R-R间期之间差值＞50 ms的 百分比（PNN50）、低频功率（LF）、高频功率（HF）、LF与HF之间的比值（LF/HF）的结果进行组间比较。采 用Spearman 相关分析分析两组患者住院次数与HRV 各指标的相关性。结果 复发性抑郁症患者组时 阈指标SDNN 高于长期住院精神分裂症组［121.0（95.0,158.0）比111.0（87.0,144.0）ms,t=2.214］,rMSSD、 PNN50 低于长期住院精神分裂症组［22.0（13.0,46.0）比20.0（12.0,28.0）ms,t=3.832;3.0（0,13.0）% 比2.0（0, 7.0）%,t=2.571］,差异均有统计学意义（均P＜ 0.05）;两组频阈指标差异无统计学意义（均P＞ 0.05）。进 一步采用Spearman 相关分析结果显示,复发性抑郁症患者住院次数与rMSSD（r=0.270,P=0.003）、PNN50 （r=0.263,P=0.004）、HF（r=0.246,P=0.015）相关,但精神分裂症患者住院次数与HRV各分析指标无相关（均 P＞ 0.05）。结论 复发性抑郁症患者的自主神经功能失调较长期住院精神分裂症患者严重,复发性抑 郁症患者的住院次数影响患者HRV时阈指标     

焦虑症的特质焦虑水平与心率变异性相关研究

目的：了解焦虑症患者的特质焦虑水平与心率变异性（HRV）这一指标相关性。方法：选取焦虑症患者50例，对其进行汉密尔顿焦虑量表（HAMA）、特质焦虑问卷（T-AI）心理评定，同时用24h动态心电图记录器，对患者进行HRV指标的测定，对其测定24h全部正常心动周期的标准差（SDNN）、正常相邻心动周期差值的均方的平方根（rMSSD）、每5min正常心动周期的标准差（SDANN）、相邻R-R间期差值超过50ins的心搏数占总心搏数的百分比（PNN50）、5min低频功率（LF）、5min高频功率（HF）、5min极低频功率（VLF）、低频和高频比值（LF／HF）8项指标分别与T-AI、HAMA分值进行分析。结果：焦虑症患者的特质焦虑分值与LF／HF具有显著相关性，但并未发现随着特质焦虑分值的增加，HRV频谱指标有差异性改变。结论：焦虑症患者的特质焦虑水平与自主神经功能不平衡性有关。     

高血压脑出血患者心率变异性与早期神经功能恶化的相关性

目的观察高血压脑出血(HCH)患者的心率变异性(HRV),记录HCH患者早期神经功能恶化(END)发生情况,并分析心率变异性与END的关系。方法选择河南科技大学第二附属医院2018-01—2019-12收治的72例HCH患者为研究对象,12例发生END,60例未发生END,于治疗前对患者实施动态心电图检查,获取HRV时域指标[24 h每5 s R-R间期平均值标准差(SDNN)、相邻R-R间期差值50 ms的心搏数占比(PNN50)、24 h相邻R-R间期差值的均方根(r-MSSD)];计算HRV频域指标[低频功率(LF)、高频功率(HF)],记录患者治疗后END发生率,分析HRV时域及频域指标与END的关系。结果 72例HCH患者的END发生率为16.67%;END组SDNN、r-MSSD、PNN50、LF、HF均低于非END组,差异有统计学意义(t=3.767、3.516、3.497、3.758、3.423,P0.001、0.001、0.001、0.001、0.001);经Logistic回归分析显示,SDNN、r-MSSD、PNN50、LF、HF低水平是HCH患者发生END的影响因素(OR=1.057、1.317、9.382、1.006、1.017,P=0.002、0.005、0.003、0.002、0.003);绘制ROC曲线显示,SDNN、r-MSSD、PNN50、LF、HF单项检测用于HCH患者END发生风险预测的AUC分别为:0.802、0.854、0.811、0.812、0.815,均0.80,均有一定预测价值。结论 HCH患者END发生率高,HRV与END发生关系密切,可考虑在未来将HRV作为HCH患者END发生的预测指标。     

重型颅脑外伤患者急性期心率变异性分析及意义

目的　探讨重型颅脑外伤患者急性期心率变异性 (HRV)变化及意义。方法　对 40例重型颅脑外伤患者急性期HRV进行测定 ,并与对照组进行比较 ,所得数据采用t检验进行处理。结果　脑外伤组HRV时域指标及频域指标均明显低于对照组 (P <0 0 1或 <0 0 5 )。脑外伤组死亡者HRV各项指标中 ,除相邻R R间期之差的标准差 (rMSSD)、相邻R R间期之差 >5 0ms的心搏数所占百分比 (PNN5 0 )、高频功率 (HF)外 ,其他各项指标均明显低于存活者 (P <0 0 5 )。脑外伤组死亡者相邻正常R R间期标准差(SDNN)、R R间期平均值的标准差 (SDANN)、R R间期标准差的平均值 (SDNNIndex)、总功率 (TP)、低频功率 (LF)分别比对照组降低了5 6 89%、5 9 44 %、5 1 65 %、65 3 9%、76 45 %。结论　重型颅脑外伤患者急性期HRV指标明显降低 ,且与预后有关。早期进行HRV分析 ,对重型颅脑外伤的预后评估具有重要的参考价值。     

抑郁症对老年2型糖尿病患者心率变异性的影响

目的 探讨抑郁症对老年2型糖尿病患者心率变异性的影响.方法 对70例老年2型糖尿病患者进行汉密尔顿抑郁量表(HAMD)测定及动态心电图测定,分为糖尿病合并抑郁症组(研究组)30例,糖尿病不合并抑郁症组(对照组)40例,比较两组患者动态心电图检查中心率变异性的变化.结果 研究组与对照组正常窦性R-R间期总体标准差分别为(81.97±11.63)ms和(111.82±14.11)ms、24 h每5 min窦性R-R间期均值标准差分别为(76.17±14.07) ms和(102.34±16.56) ms、正常连续窦性R-R间期差值均方根分别为(14.67±5.42) ms和(20.13±8.34) ms、相邻R-R间期差值＞50 ms的个数所占的百分比分别为4.65％±2.43％和7.32％±3.15％,差异均有统计学意义(P＜0.01).结论 研究组心率变异性较对照组降低,表明抑郁症增加老年2型糖尿病患者自主神经功能损害.     

糖尿病并发急性脑出血50例临床分析

目的 了解糖尿病并发急性脑出血的临床特点。方法 对50例糖尿病并发急性脑出血患者的临床资料进行回顾性分析,并与同期非糖尿病急性脑出血患者（对照组）进行比较。结果 糖尿病并发急性脑出血患者治疗后显效率和总有效率均低于对照组（P＜0．05）,而病死率高于对照 组（P＜0．01）。结论 糖尿病合并急性脑出血治疗效果差,高血糖可能损害脑部能量代谢过程。     

原发性高血压患者伴左心室肥厚与室性早搏的心率变异性及可达龙干预的探讨

目的 探讨原发性高血压(EH)患者伴左心室肥厚(LVH)与室性早搏(VPBS)的心率变异性(HRV)特点及可达龙对其治疗效果.方法 对108例EH患者伴或不伴LVH及室性早搏和80例正常人24h动态心电图(Holter)和心脏超声资料进行对比分析;频发VPBS组服用可达龙治疗6周后复查HRV,并与治疗前相比较.结果 EH患者伴LVH组的室性早搏发生率明显高于非LVH组与对照组(P＜0.05);非LVH组与对照组室性早搏的发生率无显著性差异(P＞0.05);2组患者心率变异性各指标差异无统计学意义(P＞0.05),但均明显低于对照组(P＜0.05);服用可达龙8周后HRV较治疗前明显改善(P＜0.05).结论 EH患者心率变异性与左心室肥厚的程度呈负相关,与心律失常的发生呈正相关;可达龙治疗可改善高血压伴室性早搏的HRV,改善其预后.     

原发性高血压患者心率变异性与颈动脉内膜中层厚度的相关性

目的探讨原发性高血压患者心率变异性(HRV)与颈动脉内膜中层厚度(IMT)的相关性。方法选取2014-05—2015-08就诊于我院的原发性高血压患者283例,行超声测定IMT及24h电监测,根据IMT测定结果分成IMT正常组(n=120)和IMT增厚组(n=163),比较2组间HRV时域分析指标—正常窦性R-R间期标准差(SDNN)、每5min正常窦性R-R间期平均值的标准差(SDANN)和相邻R-R间期差的均方根(RMSSD)。采用Pearson相关分析夜间SDNN、SDANN、RMSSD与IMT的相关性。结果IMT增厚组SDNN、SDANN、RMSSD显著低于IMT正常组[分别为(107.9±13.9)vs(130.5±14.7)ms,(95.6±12.9)vs(115.0±18.7)ms,(27.9±8.2)vs(37.2±9.6)ms,均P0.01];SDNN、SDANN、RMSSD与IMT均呈负相关(r=-0.403、-0.309、-0.315,均P0.01)。结论原发性高血压患者心率变异性降低与颈动脉内膜增厚有关。     

高血压性脑出血与血管紧张素转换酶基因多态性及血清水平关系的研究

目的：探讨原发性高血压（EH）,高血压性脑出血（CH）与血管紧张素转换酶（ACE）基因I／D多态性及血清ACE水平的相互关系。方法：对正常人（NC组）29例,EH组28例和CH组31例提取白细胞DNA,检测ACE基因型,等位基因和血清水平。结果：88例中不同ACE基因型血清ACE水平有显著性差异（DD＞ID＞II,P＜0．01）,EH组DD基因及D基因频率与NC组比较无显著性差异（P＜0．05）,CH组血清ACE水平和D基因频率显著高于NC组及EH组（P＜0．01）,其DD型的血清ACE水平也高于后二者（P＜0．05）,结论：ACE基因多态性及其血清水平与EH无关,而与CH呈正相关,D基因可能为高血压病患者脑出血发病的相对危险因素。     

急性脑血管病致多器官功能障碍综合征心钠素、肾素-血管紧张素-醛固酮系统机制的临床研究

目的:探讨心钠素(ANP)、肾素-血管紧张素-醛固酮系统(RAAS)在急性脑血管病(ACVD)致多器官功能障碍综合征(MODS)中的病理作用机制。方法:采用放射免疫分析法动态测定53例ACVD并或不并MODS患者及20例正常对照者血浆ANP、肾素活性(PRA)、血管紧张素-Ⅱ(AT-Ⅱ)、醛固酮(ALD)含量。结果:ACVD后血浆ANP含量较对照组显著下降,且并发MODS者下降程度大于单纯ACVD者(P<0.05);血浆PRA及AT-Ⅱ、ALD含量较对照组升高,并发MODS者升高程度大于单纯ACVD者且差异有显著性(P<0.05)。血浆ANP、PRA、AT-Ⅱ及ALD的动态变化规律随MODS的发生与否而不同。结论:血浆ANP、PRA、AT-Ⅱ及ALD的浓度可反映ACVD后下丘脑-垂体的损伤及程度,可作为判断ACVD病情及预后的客观指标。ANP、RAAS参与ACVD致MODS的发生发展过程,检测血浆ANP、AT-Ⅱ及ALD的含量可早期发现并预防MODS的发生。     

Behavioral inhibition system (BIS), behavioral activation system (BAS) and schizophrenia: relationship with psychopathology and physiology

OBJECTIVE: The Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS) have been conceptualized as two neural motivational systems that regulate sensitivity to punishment (BIS) and reward (BAS). Imbalance in BIS and BAS levels has been reported to be related to various forms of psychopathology. Since sensitivity to stress has been supposed to be a pathway for the development of psychotic symptoms, the aim of this study is to examine BIS and BAS scores in schizophrenia and their relationship with psychopathology and physiology. METHOD: Forty-two patients with schizophrenia (26 men, 16 women), stable on atypical antipsychotics, and 37 healthy controls (17 men, 20 women) were assessed with the use of the Behavioral Inhibition and Behavioral Activation scales. Since increased average heart rate (HR) and decreased heart rate variability (HRV) have been reported in patients with schizophrenia and have been shown to correlate with inhibited behaviour, these psychophysiological measures were also obtained. The BIS/BAS data and HR/HRV data were both analyzed by a (M)ANOVA. Correlation coefficients were computed for associations between BIS/BAS data, HR/HRV data, and patient variables. RESULTS: On the BIS, patients showed higher sensitivity to threat than control subjects. Higher BIS sensitivity correlated with longer duration of illness, and lower negative symptoms on the PANSS. The BAS scores did not reveal differences between patients and controls. In patients, low BAS sensitivity correlated with low dosage of medication. On the physiological measures patients showed a significantly higher HR and lower HRV compared to controls, which was limited to clozapine treated patients. No correlations were found between HR/HRV scores and BIS/BAS scores or patient variables. CONCLUSIONS: Male as well as female patients with schizophrenia are more sensitive to threat than healthy controls. This may reflect a trait-related characteristic, and is not reflected in state-related psychophysiological measures.     

急性脑血管病患者下丘脑—垂体—肾上腺皮质轴与性腺轴功能研究

急性脑血管病(ACVD)患者的PRL、GH、ACTH、LH、FSH及F水平均显著高于对照组;ACVD并发多器官功能衰竭(MOF)患者,除LH外,余5种激素水平显著高于ACVD各疾病组;随ACVD病程不同,9种激素水平也相应改变,1周时水平最高,2周后逐渐恢复;ACVD并发MOF重型患者(MOF积分>4分)PRL、GH、F水平显著高于轻型患者(MOF积分≤4分)。结果提示PRL、GH和F可能参与ACVD并发MOF的病理生理过程。     

Autonomic and emotion regulation in bereavement and depression

OBJECTIVES: Prior research suggests important differences between depression and the depressed feelings experienced in the context of bereavement, despite some overlap. Differences include an increase in restlessness, suggesting underlying physiological differences between the groups. METHOD: This study examined the level of depressive symptoms, heart rate (HR), and heart rate variability (HRV), and coping style of 10 bereaved, 10 depressed, and 10 control participants. RESULTS: Bereaved participants showed significantly higher HR than either depressed or control participants, while there were no such differences in HRV. Level of depression in the bereaved group correlated negatively with HRV. Additional analyses showed that the use of passive coping had a marginally significant negative correlation with HRV in bereaved subjects. CONCLUSION: The present data suggest that differences in HR and HRV could be associated with increased cardiovascular fatalities in bereaved individuals, known as the "broken heart phenomenon." These physiological differences have potential implications for both the mental and physical health of the bereaved.     

脑梗死后心率变异的常见临床因素分析

目的 研究脑梗死患者心率变异性(HRV)的特点及其影响因素,为脑梗死的治疗提供有意义的借鉴.方法 研究梅州市人民医院神经内科自2007年5月至2009年6月收治、经CT或MRI检查确诊的190例脑梗死患者的临床资料,以同期健康体检者50例做为对照,利用24 hHRV分析技术测定并比较心脏自主神经活性受损程度,再按照脑梗死患者的年龄、性别、梗死类型、病情程度、预后、梗死部位对病例进行分组并分析上述因素对患者HRV的影响.结果 脑梗死组患者HRV相关指标均低于对照组;≥60岁组患者HRV各项指标低于<60岁组;除总功率谱(TF)外,女性HRV指标均低于男性,腔隙性梗死患者HRV指标高于动脉粥样硬化性腩梗死和脑栓塞患者,GCS评分较低的患者HRV指标较低,预后为死亡的患者HRV指标最低,其次为好转、治愈患者.右岛叶梗死患者HRV时域指标低于其他梗死部位患者,差异均有统计学意义(P<0.05).结论 脑梗死患者自主神经系统失衡,早期动态监测HRV可以判断脑梗死患者脑功能损伤程度及病情演变趋势,有助于早期识别高危患者,指导临床治疗.     

Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)--results of a preliminary investigation

EMDR combines stimuli that evoke divided attention - e.g. eye movements - with exposure to traumatic memories. Our objective was to investigate psycho-physiological correlates of EMDR during treatment sessions. A total of 55 treatment sessions from 10 patients with PTSD was monitored applying impedance cardiography. Onset of every stimulation/exposure period (n=811) was marked and effects within and across stimulation sets on heart rate (HR), heart rate variability (HRV), pre-ejection period (PEP) and respiration rate were examined. At stimulation onsets a sharp increase of HRV and a significant decrease of HR was noticed indicating de-arousal. During ongoing stimulation, PEP and HRV decreased significantly while respiration rate significantly increased, indicating stress-related arousal. However, across entire sessions a significant decrease of psycho-physiological activity was noticed, evidenced by progressively decreasing HR and increasing HRV. These findings suggest that EMDR is associated with patterns of autonomic activity associated with substantial psycho-physiological de-arousal over time.     

Blood pressure and heart rate variability in patients with essential hyperhidrosis

Introduction Essential hyperhidrosis (EH) is often considered to be related to an increased activity of sympathetic nervous system (SNS). However, there is a lack of studies comparing autonomic nervous system (ANS) activity in controls and in EH patients. The aim of the present study was to simultaneously investigate in patients with severe EH, blood pressure, heart rate variability and plasma catecholamine levels in comparison with controls.Methods 19 EH patients and 20 controls with normal ANS function assessed by clinical testing were included. Blood pressure (BP) and heart rate (HR) were measured using a Finapres beat-to-beat monitor. BP and HR variabilities (Fast Fourier transformation) and plasma catecholamine levels (HPLC) were obtained at rest and during a 15 min 70° head-up tilt test.Results At rest, a significantly higher relative energy of low frequency band (LF) of systolic BP was observed in EH in comparison with controls contrasting with the lack of difference in BP, HR, plasma catecholamine levels and in other spectral parameters. During tilt, all changes were comparable in EH and in control subjects excepting relative energy of LF of SBP which remained unchanged when compared to the resting condition in EH group.Conclusions In EH, SNS is not overreactive even if resting overactivity cannot be excluded.     

Heart rate, tonic cardiac variability and evaluation

Heart rate (HR) and various measures of heart rate variability (HRV) were measured while 29 male and 15 female student volunteers individually rated slide stimuli presented in one-minute intervals. Ratings were factor analyzed and factor scores analyzed as variables. Factor one: “evaluation” accounted for 52.5% of the variances. HR and HRV were not significantly related to the experimental conditions although factor one was related. HR was correlated to measures of HRV [such as the coefficient of variability (CV), coefficient of temporal variability (CVT), a cosine function (FREQ) and to a lesser degree the auto-correlation (RA)]. HR also correlated linearly to evaluation. CVT, CV and RA were also linearly correlated to evaluation. HRV (BURST) was independent of HR, other forms of HRV, and curvilinearly related to evaluation. A cyclic HRV function (FREQ) was found with a mode of 18.7 sec and accounted for 21.4% of the variance of the heart beat data. This cyclic function, not reported previously, should be further investigated.     

急性脑血管病并／不并多器官功能衰竭患者下丘脑—垂体—肾上腺皮质轴功能研究

应用放射免疫分析法对１６７例急性脑血管病（ＡＣＶＤ）患者血清泌乳素（ＰＲＬ）、生长激素（ＧＨ）、皮质醇（Ｆ）及血浆促肾上腺皮质激素（ＡＣＴＨ）水平变化进行了观察。结果发现：ＡＣＶＤ患者ＰＲＬ、ＧＨ、ＡＣＴＨ与Ｆ水平均显著高于对照组，ＡＣＶＤ并多器官功能衰竭（ＭＤＦ）患者４种激素水平显著高于ＡＣＶＤ各疾病组，随ＡＣＶＤ病程不同，４种激素水平也相应改变，１周时水平最高，２周后逐渐恢复、ＡＣＶＤ并ＭＤＦ重型患者（ＭＤＦ积分＞４分）ＰＲＬ、ＧＨ与Ｆ水平显著高于轻型患者（ＭＤＦ积分≤４分）。结果提示ＰＲＬ、ＧＨ和Ｆ可能参与了ＡＣＶＤ并ＭＤＦ的病理生理过程。