Heart rate variability and sympathetic skin response in male patients suffering from acute alcohol withdrawal syndrome

BACKGROUND: Many symptoms of alcohol withdrawal (AW) such as tachycardia or elevated blood pressure might be explained by increased peripheral and central adrenergic activity. In contrast to many neurochemical studies of sympathetic activation during AW, only very few studies investigated autonomic balance using neurophysiological methods. METHODS: We investigated heart rate variability (HRV) and sympathetic skin response (SSR) in male patients suffering from mild AW syndrome (n = 20, no treatment required) and in patients with moderate to severe AW syndrome (n = 20, clomethiazole treatment) in the acute stage. Sympathovagal influence was quantified using measures of time and frequency domain of HRV as well as modern nonlinear parameters (compression entropy). Furthermore, we obtained latencies and amplitudes of SSR to quantify isolated sympathetic influence. Measures were obtained during the climax of withdrawal symptomatology before treatment, 1 day after climax, and shortly before discharge from hospital. Alcohol withdrawal scores were obtained and correlated to autonomic measures. RESULTS: Ambulatory blood pressure and AW scores revealed characteristic withdrawal symptoms in both patient groups. Apart from the nonlinear parameter compression entropy, Hc, measures of HRV revealed no sign of autonomic dysfunction in contrast to the significantly increased heart rates at the time of admission. Latencies and amplitudes of SSR did not indicate any increase of sympathetic activity. A negative correlation was found between Hc and mental withdrawal symptoms. CONCLUSIONS: We show here that classical measures for autonomic nervous system activity such as HRV and SSR are not suitable for describing the autonomic changes seen in acute AW, although a major role for the sympathetic nervous system has been proposed. This might be due to multiple dysregulation of metabolites in AWS or to subtle alcohol-induced damage to neuronal structures, issues that should be addressed in future studies.     

扩张性心肌病心率变异性及QT离散度和心功能的关系

目的:探讨扩张型心肌病(DCM)患者,心率变异性(heart rate variability,HRV)及QT离散度(QTdispersion,QTd)与心功能的相关性。方法:45例临床诊断DCM患者,按NYHA心功能标准分级,A组(心功能Ⅰ～Ⅱ级)16例,B组(Ⅲ～Ⅳ级)29例;检测各组HRV时域指标、QTd、左室射血分数(LVEF)及左室舒张末期内径(LVDd),与正常对照组比较.并检测其相关性。结果:与正常对照组比较,DCM患者HRV各项时域指标显著降低(P<0.05～<0.001),QTd显著增加(P<0.001);且随着心功能恶化,HRV时域指标下降,QTd增加越趋明显(P均<0.001);HRV各时域指标与QTd及LVDd呈显著负相关(P<0.001),与LVEF呈显著正相关(P<0.001);QTd与LVEF及LVDd也育显著相关性(P<0.001)。结论:HRV和QTd变化与DCM患者的心功能恶化是一致的,对预测DCM患者预后有较高价值,是一种简单的无创评定方法。     

Attenuated heart rate responses to public speaking in individuals with alcohol dependence

BACKGROUND: Because individuals with alcohol dependence (AD) have shown blunted cortisol responses to psychological stress, we assessed whether they also show attenuated cardiovascular responses. This study examined the cardiovascular responses of people meeting DSM-IV criteria for AD to orthostasis and public speaking. METHODS: Heart rate (HR), stroke volume, cardiac output, total peripheral resistance, mean arterial pressure, systolic blood pressure, and diastolic blood pressure during orthostasis and public speaking were assessed by use of impedance cardiography and Dinamap blood pressure monitoring in 20 AD subjects abstinent for 21 to 28 days and in 10 age-matched controls. Orthostasis consisted of standing, whereas public speaking involved preparing and presenting two speeches. Self-reported mood state was also assessed during the tasks. RESULTS: AD subjects had significantly lower resting BP compared with controls. Cardiovascular responses to orthostasis were similar between groups. AD subjects had attenuated HR during public speaking but reported similar anxiety responses to controls. CONCLUSIONS: Comparable cardiovascular responses to orthostasis in controls and AD subjects suggest intact reflex control of circulation. AD subjects had blunted HR responses to public speaking; this is consistent with the attenuated cortisol responses observed in this sample and in previous studies. This suggests a possible alteration in limbic system regulation of hypothalamic and brainstem responses to psychological stress. Cardiovascular responses of AD subjects that are inconsistent with subjective accounts of tension and anxiety suggest a disconnection between perception of threat and resulting physiologic responses in AD subjects.     

Heightened heart rate response to alcohol intoxication is associated with a reward-seeking personality profile

BACKGROUND: The psychomotor stimulant theory of addiction posits that sensitivity to the positively rewarding properties of alcohol puts certain individuals at higher risk for alcohol abuse. A valid and reliable index of overactivation in the reward system has been a heightened baseline heart rate (HR) increase on the ascending limb of the blood alcohol curve. The main goal of this study was to investigate the relationship between this HR response and a questionnaire measuring sensitivity to reward and sensitivity to punishment. Additional goals included looking at (1). the association between a high HR response and various personality traits (hopelessness/introversion, anxiety sensitivity, impulsivity, and sensation-seeking) and (2). the relationship between these personality traits and stimulant use. METHODS: A total of 18 low- and 19 high-HR responders completed the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), the Substance Use Risk Profile Scale (SURPS), and a modified version of the Addiction Severity Index. RESULTS: High-HR responders obtained significantly higher scores than low-HR responders on the sensitivity to reward scale of the SPSRQ, as well as increased sensation-seeking scores on the SURPS. High-HR responders were not at significantly higher risk of having used stimulants, but stimulant use was associated with higher impulsivity scores on the SURPS. CONCLUSIONS: Novelty/sensation-seeking is among the personality traits that have been linked to heavy alcohol use. This study suggests that reward sensitivity might mediate the relationship between this personality profile and drinking behavior.     

Moderate alcohol consumption and postprandial plasma lipids in men with different risks for coronary heart disease

BACKGROUND: Moderate alcohol consumption is associated with a reduced coronary heart disease (CHD) risk. Epidemiologic studies have provided conflicting data which suggests that CHD protection may be modulated or may not be modulated by a person's CHD risk profile. METHODS: We examined the effects of moderate alcohol consumption (35 g/day) on postprandial lipoprotein metabolism in two groups of healthy middle-aged men who had different plasma total cholesterol, triglyceride concentrations, and body mass index (BMI), which are three major risk factors for CHD; 11 men had lower plasma lipids and BMI (L-men) and 11 men had higher plasma lipids and BMI (H-men). The effects of alcohol on postprandial lipoprotein metabolism were studied in a crossover design after an acute moderate alcohol intake both after a period of abstinence (alcohol-free beer) and after a period of moderate alcohol consumption (alcohol containing beer). RESULTS: Moderate alcohol consumption changed plasma total cholesterol, total triglycerides, and HDL composition in the postprandial period. Alcohol-induced changes were essentially the same over time in both L-men and H-men. However, changes occurred at a different overall plasma concentration for total cholesterol and total triglycerides. Also, the postprandial response to an acute moderate alcohol dose after a period of abstinence seemed not to essentially differ from the response to an acute moderate alcohol dose after a 4-week period of moderate alcohol consumption. CONCLUSIONS: These results suggest that men who differ in risk for CHD, based on plasma lipids and BMI, but without previous or underlying disease, have a similar postprandial lipid response to a moderate dose of alcohol.     

糖尿病患者心率变异性研究

目的 研究糖尿病心率变异性（ＨＲＶ）特征及相关因素。方法 （１）对３３８例无甲亢、高血压、冠心病等其它心脏病的糖尿病患者和１０３例正常人进行了ＨＲＶ分析。（２）对糖尿病患者年龄、疾病分型、病程、慢性并发症等与ＨＲＶ的关系进行单因素和多因素分析。结果 （１）糖尿病各年龄段ＨＲＶ值均低于对照组（Ｐ〈０．０１）。（２）糖尿病ＨＲＶ与年龄、病程、糖化血红蛋白水平、慢性并发症密切相关。结论 糖尿病ＨＲＶ降低     

急性冠脉综合征患者窦性心率震荡变化特点及其与心率变异性的相关性研究

目的分析急性冠脉综合征（ACS）患者窦性心率震荡（HRT）指标变化特点及其与心率变异性（HRV）的相关性。方法应用相应的分析软件对与59名健康体检者和161例确诊为ACS的患者24h动态心电图检查结果进行分析,检测HRT参数震荡初始（TO）、震荡斜率（TS）和HRV时域指标24h正常RR间期标准差（SDNN）、全程相邻窦性R—R间期之差的均方根值（rMSSD）、相邻正常RR间期差值〉50ms的心搏数占总RR间期数的百分比（PNN50）。将ACS组分为不稳定型心绞痛（UAP）组和急性心肌梗死（AMI）组,比较HRT、HRV指标和HRT异常的发生率在各组间的差异,进一步探讨ACS患者HRT和HRV指标相关性。结果与健康对照组比较,UAP组及AMI组TO明显增高,TS显著降低（均P〈0．01）;UAP组及AMI组间TO和TS无显著差异。UAP组及AMI组HRT异常率较对照组显著升高（X^2=5．385,P〈0．05;r=9．227,P=0．01）。UAP组及AMI组HRV指标SDNN、rMSSD、PNN50较对照组显著降低（均P〈0．01）,AMI组SDNN较UAP组降低（P〈0．05）,rMSSD、PNN50差异无统计学意义。ACS患者的TO与SDNN呈负相关（r=-0．26,P=0．031）,与rMSSD、PNN50不相关,TS与SDNN、PNN50、RMSSD呈正相关,其中和SDNN的相关性最强（r=0．301,P=0．047）。结论HRT可作为ACS危险分层的一项新的心电学筛选指标。ACS患者HRT、HRV变化从不同方面反映心脏迷走神经的功能受损,二者互相联系又相互独立。     

Heart rate response to alcohol and intoxicated aggressive behavior

BACKGROUND: This study examined the elevated heart rate (HR) response to alcohol intoxication, thought to reflect an increased sensitivity to alcohol-induced reward, as a potential factor in the increased likelihood of alcohol-induced aggression. METHODS: Three groups, intoxicated high (n=37) and low (n=37) HR responders and sober controls (n=73), participated in a laboratory measure of physical aggression, the Taylor Aggression Paradigm. RESULTS: Results revealed that intoxicated high HR responders were more aggressive than the intoxicated low HR responders and sober controls. CONCLUSIONS: These findings are interpreted within a hypothetical model relating increased alcohol-induced aggression to a dysregulation in the motivational system responding to rewards.     

Effects of conditioned reward and nonreward cues on the heart rate response to alcohol intoxication in male social drinkers

BACKGROUND: An exaggerated heart rate (HR) increase following alcohol intoxication has been suggested to reflect sensitivity to alcohol-induced reward. The goal of this study is to verify whether pairing alcohol ingestion with conditioned reward and nonreward cues can influence HR responses to alcohol in previously identified individuals with a low and a high HR response. METHODS: Fifty-six male social drinkers participated in a 2-day study. On day 1, participants consumed 0.75 g/kg of body weight of pure ethanol. A median split of the alcohol-induced HR responses identified groups of low and high HR responders. On day 2, both groups participated while sober in a computer task where distinct auditory and visual cues were paired either with monetary reward or no monetary reward. Subsequently, participants were randomly assigned to an alcohol challenge, which occurred while they were exposed to either the conditioned cues of reward or to the nonreward cues. RESULTS: The physiological response to alcohol intoxication on day 2 was compared with alcohol-induced HR responses on day 1 (neutral alcohol challenge) for both low and high HR responders. Paired t-tests showed that high HR responders had significantly decreased alcohol-induced HR responses on day 2 in the nonreward condition when compared with day 1. No other relationships between cardiac responses to alcohol and cue conditions were obtained. CONCLUSIONS: The rewarding nature of alcohol can be altered by the context in which it is consumed in a subset of individuals who are sensitive to alcohol's stimulating properties.     

β—受体阻滞剂早期治疗对急性心肌梗死患者心率变异的影响

目的 研究早期使用β－受体阻滞剂对急民生心肌梗死患者心率变异的影响。方法 ４４例急性心肌梗死患者入院后随机分为β－受体阻滞剂治疗组（１８例）和对照组（２６例）。治疗组于即刻给予氨酰心安（１２．５～２５ｍｇ／天）,或美多心安（２５～５０ｍｇ／天）,余两组治疗相同,入院后１０～１４天行２４小时动态心电图检查,分别析时域指标ＳＮＤＤＳＤＡＮＮｒＭＳＳＤＰＮＮ５０,散点图指标ＶＬＩ,ＶＡＩ的变化,用配对ｔ     

美托洛尔和苯那普利对急性心肌梗死患者心率变异性的影响

目的：评价美托洛尔和苯那普利对急性心肌梗死（AMI）患者心率变异性的影响,方法：无合并症的AMI患者共49例,15例为美托洛尔组,15例为苯那普利组,19例为安慰剂组,于心肌梗死后5－7d及治疗30d后行24h动态心电图检查,观察心率变异性的时域指标和频域指标的变化,结果：心肌梗死后各组的心率变异性明显减低,美托洛尔和苯那普利治疗后,心率变异性的时域指标和频域指标均明显改善,结论,美托洛尔和苯那普利可以明显改善无合并症AMI患者的心率变异性。     

麝香保心丸对老年急性冠脉综合征患者心率变异的影响

目的:观察麝香保心丸对老年急性冠脉综合征(ACS)心率变异(HRV)的影响,评价其心肌保护作用。方法:90名老年ACS患者,随机分为麝香保心丸及常规治疗组,分别于用药前、后记录24 h Holter,观察心绞痛症状及心电图变化,进行HRV分析。结果:麝香保心丸组心绞痛明显改善(P<0.05)。SDNN、SDANN、rMSSD、PNN 均升高,极低频(VLF)、低频(LF)、LF/HF均降低(P均<0.05)。结论:麝香保心丸能有效改善ACS患者心肌缺血症状及心率变异。     

Measures of current alcohol consumption and problems: two independent twin studies suggest a complex genetic architecture

Background: Twin studies demonstrate that measures of alcohol consumption (AC) show evidence of genetic influence, suggesting they may be useful in gene identification efforts. The extent to which these phenotypes will be informative in identifying susceptibility genes involved in alcohol dependence depends on the extent to which genetic influences are shared across measures of AC and alcohol problems. Previous studies have demonstrated that AC reported for the period of heaviest lifetime drinking shows a large degree of genetic overlap with alcohol dependence; however, many studies with genetic material assess current AC. Further, there are many different aspects of AC that can be assessed (e.g., frequency of use, quantity of use, and frequency of intoxication). Methods: Here, we use data from 2 large, independent, population‐based twin samples, FinnTwin 16 and The Virginia Adult Twin Study of Psychiatric and Substance Use Disorders, to examine the extent to which genetic influences are shared across many different measures of AC and alcohol problems. Results: Genetic correlations across current AC measures and alcohol problems were high across both samples. However, both samples suggest a complex genetic architecture with many different genetic factors influencing various aspects of current AC and problems. Conclusions: These results suggest that careful attention must be paid to the phenotype in efforts to “replicate” genetic effects across samples or combine samples for meta‐analyses of genetic effects influencing susceptibility to alcohol‐related outcomes.     

左卡尼汀对急性心肌梗死患者QT离散度及心率变异性的影响

目的研究左卡尼汀对急性心肌梗死（AMI）患者QT离散度（QTd和QTcd）心率变异性（HaY）的影响。方法120例AMI患者被随机分为常规治疗组（60例）和左卡尼汀治疗组（60例）。两组均给予常规治疗,左卡尼汀治疗组在此基础上加用左卡尼汀3．0g静脉滴注,每日1次,14d为一个疗程。评价治疗前后QT离散度和心率变异性指标的改变。结果与治疗前比较,两组患者QTd、QTcd明显降低（P〈0．05或P〈0．01）,各项时域指标均明显升高（P〈0．05或P〈0．01）,频域指标LF、LF／HF降低,HF升高（P〈0．05或P〈0．01）,两组治疗后比较差异有统计学意义（P〈0.05）。结论左卡尼汀可以显著缩短AMI患者QT离散度,提高心率变异性,改善缺血心肌电不稳定性。     

充血性心力衰竭心率变异性改变及其与心室重塑的关系

目的:检测充血性心力衰竭患者心率变异性(HRV)改变,探讨其与心室重塑的关系。方法:采用Holter检查系统检测了36例CHF患者HRV指标24h正常R-R间期标准差(SDNN)、24h内每5min平均正常R-R间期的标准差(SDANN)24h内每5min的正常R-R间期标准差的平均值(SDNNI),相邻正常R-R间期差值的均方根(rMSSD),相邻正常R-R间期差值≥50ms心搏数占总R-R间期数的百分数(PNN50)及超声心动图指标左心室舒张末期内径(LVEDD),收缩末期内径(LVESD),左心室后壁舒张末期厚度(LVPWT),心室间隔舒张末期厚度(IVST),左心室射血分数(LVEF),左心室舒张早期及舒张晚期充盈速度比值(E/A)及左心室重量指数(LVMI),并以20例健康体检者为对照。结果:CHF患者HRV各时域指标均下降,与对照组相比有显著差异(P<0.05～<0.01)。多元回归分析显示SDNN,SDNNI与LVEDD,LVPWT呈负相关(r=-0.337～-0.362,P<0.05);rMSSD,PNN50与LVEDD,LVESD呈负相关(r=-0.142～-0.433,P<0.05);rMSSD、PNN50与LVEF呈正相关(r=0.387～0.464,P<0.05～<0.001)。结论:CHF患者HRV下降,并与心室重塑有关。     

Timing accuracy and variability in children with prenatal exposure to alcohol

BACKGROUND: Prenatal exposure to alcohol (prenatal alcohol exposure) is associated with gross and fine motor skill dysfunction. The present study examined performance on two types of timing tasks to determine the extent to which prenatal alcohol exposure affects perception, movement planning, and movement execution during tasks that require temporal processing. METHODS: Fourteen children with confirmed heavy prenatal alcohol exposure and 22 control children (aged 5-10 years) completed two timing tasks: a coincident-anticipation timing task that primarily assessed central processing, and a movement-speed timing task that evaluated the motor component of temporal processing. Absolute error, signed error, and variability of the participant's signed error were the dependent variables. RESULTS: For both timing tasks, children with prenatal alcohol exposure were significantly less accurate and more variable than control children, indicating that both the sensory-perceptual and motor components of temporal processing were disrupted in alcohol-exposed children. CONCLUSIONS: Alcohol-exposed children had difficulty producing accurate and consistent motor responses when intercepting a moving target or moving through a spatial target in a specified amount of time. Disruptions in these motor timing behaviors may be indicative of alcohol-related cerebellar or basal ganglia damage.