抑郁症与精神分裂症患者心率变异性的对照分析

目的探讨抑郁症与精神分裂症患者的心率变异性（HRV）的差异。方法对36例首次发作的抑郁症患者及年龄、性别与之相匹配的41例首次发作的精神分裂症患者分别进行短时程HRV检测,并对其心率变异指标SDNN、MSD、rMSSD、PNN50、LF、HF、LF/HF结果进行分析。结果抑郁症患者的时阈指标rMSSD（P〈0.05）、PNN50（P〈0.01）较精神分裂症显著降低,而两者之间的频阈分析指标无明显差异。结论抑郁症患者的自主神经功能失调较精神分裂症患者更严重。     

Diminished chaos of heart rate time series in patients with major depression.

BACKGROUND: Depression and anxiety have been linked to serious cardiovascular events in patients with preexisting cardiac illness. A decrease in cardiac vagal function as suggested by a decrease in heart rate (HR) variability has been linked to sudden death. METHODS: We compared LLE and nonlinearity scores of the unfiltered (UF) and filtered time series (very low, low, and high frequency; VLF, LF and HF) of HR between patients with depression (n = 14) and healthy control subjects (n = 18). RESULTS: We found significantly lower LLE of the unfiltered series in either posture, and HF series in patients with major depression in supine posture (p <.002). LLE (LF/UF), which may indicate relative sympathetic activity was also significantly higher in supine and standing postures in patients (p <.05); LF/HF (LLE) was also higher in patients (p <.05) in either posture. CONCLUSIONS: These findings suggest that major depression is associated with decreased cardiac vagal function and a relative increase in sympathetic function, which may be related to the higher risk of cardiovascular mortality in this group and illustrates the usefulness of nonlinear measures of chaos such as LLE in addition to the commonly used spectral measures.     

氟西汀联合舒肝解郁胶囊治疗抑郁症的效果及对患者心率变异性的影响

背景 抑郁症可能导致患者存在较高的自杀风险,严重影响患者和家属的生活质量,给社会带来较大负担。虽然西药中的抗抑郁药疗效确切,但单一使用对抑郁症状改善相对局限,且联用两种抗抑郁药可能增加不良反应。中成药与西药合理配伍使用可能起到相辅相成的效果,且中成药安全性较高。目的 探讨氟西汀联合舒肝解郁胶囊治疗抑郁症的效果,比较氟西汀联合舒肝解郁胶囊与单用氟西汀的疗效、安全性以及对患者心率变异性影响的差异,为抑郁症患者的临床用药提供参考。方法 收集2015年12月-2016年6月在新乡医学院第二附属医院门诊就诊和住院治疗的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）抑郁症诊断标准的64例患者为研究对象,采用随机数字表法分为联合用药组和氟西汀组各32例。两组均接受氟西汀治疗,联合用药组在此基础上联用舒肝解郁胶囊。治疗前,两组均接受汉密尔顿抑郁量表24项版（HAMD-24）和汉密尔顿焦虑量表（HAMA）评定以及心率变异性（HRV）分析,并于治疗第2、4、6周末接受HAMD-24和副反应量表（TESS）评定,治疗第6周末再次进行HRV分析。结果 最终共60例抑郁症患者完成研究,联合用药组和氟西汀组各30例。治疗第2、4、6周末,联合用药组HAMD-24评分均低于氟西汀组,差异均有统计学意义（t=-2.677、-3.960、-4.432,P<0.05或0.01）。与治疗前相比,联合用药组在治疗第6周末24小时平均正常RR间期标准差（SDNN）、标化低频功率（nLF）以及标化高频功率（nHF）均较高（t=-73.970、-31.878、-38.721,P均<0.01）,而低频功率与高频功率之比（LF/HF）较低（t=3.525,P<0.01）。治疗第6周末,联合治疗组总有效率高于氟西汀组,差异有统计学意义（86.67% vs. 70.00%,χ²=18.764,P<0.01）。治疗第2、4、6周末,两组不良反应发生例数差异均无统计学意义（P均>0.05）。结论 与单用氟西汀相比,舒肝解郁胶囊联合氟西汀对抑郁症的临床疗效和改善患者心率变异性方面可能更好,且不增加不良反应。     

抑郁症焦虑症患者心率变异性特点的对比研究

目的探讨抑郁症、焦虑症患者自主神经功能的特点。方法随机选择42例抑郁症患者,10例焦虑症患者和17例健康对照者分别接受短时心率变异性分析,记录相关考察指标,进行统计学分析。结果心率变异性分析的各项考察指标中,各观察组均有一项或多项低于正常对照组（P〈0．05）;且各组之间互相对比分析P〈0．05。结论抑郁症、焦虑症患者均存在心率变异性的降低,其自主神经功能活性降低。抑郁症患者因伴或不伴有焦虑症状,其心率变异指标不同,可以指导治疗。     

脑中风患者心率变异的初步分析

目的：探讨中风后植物神经的变化规律及其变化机制。方法：采用反映植物神经功能折心率变异指标，对其时域指标进行分析、应用方差分析及ｔ检验，比较了健康对照组与中风组的心率变异情况。结果：（１）中风组ＳＤＮＮ及ＨＲＶＩ均明显低于健康对照组。（２）中风组随病程的处长，其心率变异逐渐增高，到半年后基本恢复到对照组的水平。     

Depression recognition according to heart rate variability using Bayesian Networks

BackgroundDoctors mainly use scale tests and subjective judgment in the clinical diagnosis of depression. Researches have demonstrated that depression is associated with the dysfunction of the autonomic nervous system (ANS), where its modulation can be evaluated by heart rate variability (HRV). Depression patients have lower HRV than healthy subjects. Therefore, HRV may be used to distinguish depression patients from healthy people.MethodsHRV signals were collected from 76 female subjects composed of 38 depression patients and 38 healthy people. Time domain, frequency domain, and non-linear features were extracted from the HRV signals of these subjects, who were subjected to the Ewing test as an ANS stimulus. Then, these multiple features were input into Bayesian networks, served as a classifier, to distinguish depression patients from healthy people. Hence, accuracy, sensitivity, and specificity were calculated to evaluate the performance of the classifier.ResultsRecognition results indicate 86.4% accuracy, 89.5% sensitivity, and 84.2% specificity. The individuals subjected to the Ewing test showed better recognition results than those at individual test states (resting state, deep breathing state, Valsalva state, and standing state) of the Ewing test. The root mean square of successive differences (RMSSD) of the HRV exhibits a significant relevance with recognition.ConclusionBayesian networks can be applied to the recognition of depression patients from healthy people and the recognition results demonstrate the significant association between depression and HRV. The Ewing test is a good ANS stimulus for acquiring the difference of HRV between depression patients and healthy people to recognize depression. The RMSSD of the HRV is important in recognition and may be a significant index in distinguishing depression patients from healthy people.     

A systematic review and meta-analysis of randomized controlled trials of adjunctive ketamine in electroconvulsive therapy: Efficacy and tolerability

BackgroundElectroconvulsive therapy (ECT) remains one of the most effective tools in the psychiatric treatment armamentarium, particularly for refractory depression. Yet, there remains a subset of patients who do not respond to ECT or for whom clinically adequate seizures cannot be elicited, for whom ketamine has emerged as a putative augmentation agent.MethodsWe searched EMBASE, PsycINFO, CENTRAL, and MEDLINE from 1962 to April 2014 to identify randomized controlled trials evaluating ketamine in ECT (PROSPERO #CRD42014009035). Clinical remission, response, and change in depressive symptom scores were extracted by two independent raters. Adverse events were recorded. Drop-outs were assessed as a proxy for acceptability. Meta-analyses employed a random effects model.ResultsData were synthesized from 5 RCTs, representing a total of 182 patients with major depressive episodes (n = 165 Major Depressive Disorder, n = 17 Bipolar Disorder). ECT with ketamine augmentation was not associated with higher rates of clinical remission (Risk Difference (RD) = 0.00; 95%CI = −0.08 to 0.10), response (RD = −0.01; 95%CI = −0.11 to 0.08), or improvements in depressive symptoms (SMD = 0.38; 95%CI = −0.41 to 1.17). Ketamine augmentation was associated with higher rates of confusion/disorientation/prolonged delirium (OR = 6.59, 95%CI: 1.28–33.82, NNH = 3), but not agitation, hypertension or affective switches.ConclusionOur meta-analysis of randomized controlled trials of ketamine augmentation in the ECT setting suggests a lack of clinical efficacy, and an increased likelihood of confusion. Individuals for whom adequate seizures or therapeutic response cannot be obtained have not been studied using randomized controlled designs. Additional research is required to address the role of ketamine in this population.     

Heart rate variability and cordance in rapid eye movement sleep as biomarkers of depression and treatment response

ObjectivesThe relevance of rapid eye movement (REM) sleep in affective disorders originates from its well-known abnormalities in depressed patients, who display disinhibition of REM sleep reflected by increased frequency of rapid eye movements (REM density). In this study we examined whether heart rate variability (HRV) and prefrontal theta cordance, both derived from REM sleep, could represent biomarkers of antidepressant treatment response.MethodsIn an open-label, case-control design, thirty-three in-patients (21 females) with a depressive episode were treated with various antidepressants for four weeks. Response to treatment was defined as a ≥50% reduction of HAM-D score at the end of the fourth week. Sleep EEG was recorded after the first and the fourth week of medication. HRV was derived from 3-min artifact-free electrocardiogram segments during REM sleep. Cordance was computed for prefrontal EEG channels in the theta frequency band during tonic REM sleep.ResultsHRV during REM sleep was decreased in depressed patients at week four as compared to controls (high effect size; Cohen's d > 1), and showed a negative correlation with REM density in both, healthy subjects and patients at week four. Further, the fourteen responders had significantly higher prefrontal theta cordance as compared to the nineteen non-responders after the first week of antidepressant medication; in contrast, HRV at week one did not discriminate between responders and non-responders.ConclusionsOur data suggest that HRV in REM sleep categorizes healthy subjects and depressed patients, whereas REM sleep-derived prefrontal cordance may predict the response to antidepressant treatment in depressed patients.     

癫痫患者发作间期心率功率谱的测定及其临床意义

目的 探讨心率功率谱（HRPSA）测定对评价癫痫患者发作间期心血管系统自主神经功能状态的意义。方法 测定48例癫痫患者和31例健康对照者的HRPSA，分析其心率变异性（HRV）。结果 癫痫患者发作间期HRV降低，接受卡马西平（CBZ）治疗后HRV降低更明显。结论 癫痫患者发作间期心血管系统自主神经功能存在紊乱现象，CBZ治疗后这种现象更明显。     

Differential pattern of heart rate variability in patients with schizophrenia

The cardiac autonomic dysfunction has been reported in patients with schizophrenia. Heart rate variability (HRV) provides non-invasive indices of cardiac autonomic modulation. This study examined whether patients with schizophrenia may show a distinctive pattern of HRV compared to healthy controls. Nine measures of time, frequency and complexity domains were extracted from 5-min resting evaluation of HRV in 30 unmedicated patients with schizophrenia and 30 age- and gender-matched controls. In addition to inferential statistics, a hierarchical clustering (HC) was used to examine difference in the interrelationships among HRV measures between the two groups. Multivariate analysis of variance revealed a significant group effect. Significantly lower sample entropy (SampEn) and a trend towards a higher ratio of low- to high frequency (LF/HF) were observed in the schizophrenia group. In the results of HC using Ward's method, SampEn co-clustered with LF/HF ratio in patients with schizophrenia compared to the separation of LF/HF ratio in healthy controls. In concert with decreased parasympathetic activity, low complexity of heart rate dynamics may reduce adaptability of cardiovascular system to changes in internal or external environment, thus increasing the risk of cardiovascular events. Diverse HRV measures combined in a multivariate fashion appear to be useful in understanding the pattern of neurocardiac modulation in patients with schizophrenia.     

癫癎患者发作间期心血管自主神经功能与心率变异性

目的　探讨癫　患者发作间期心血管自主神经功能与心率变异性（ＨＲＶ）的变化。方法　５１例癫　患者根据标准心血管自主神经功能试验结果分为阳性（ＡＮＦＴ＋）组及阴性（ＡＮＦＴ－）组,与正常对照组３６例对比,进行ＨＲＶ分析。结果　癫　患者发作间期心血管自主神经功能异常率为４５．１％,且病程越长异常率越高。癫　患者在ＨＲＶ时域分析及非线性定量分析指标上均较对照组降低,且以　ＡＮＦＴ＋组患者最明显。ＨＲＶ直方图、散点图亦有特征性改变,以ＡＮＦＴ＋组患者最为显著。结论　癫　患者发作间期心血管自主神经功能存在紊乱现象,这种现象可能与癫　患者的猝死发生有关,ＨＲＶ是测定这一变化的敏感方法。     

Genetic factors contribute to the variance in frequency domain measures of heart rate variability

Power spectral analysis of heart rate variability (HRV) provides quantitative phenotypic markers of autonomic nervous system activity. Reported determinants of HRV only partially explain its variability in the population. The purpose of this study was to estimate the contribution of genetic factors to the variance in HRV measures and assess the heritability of HRV. Subjects who underwent Holter recordings at a routine examination were eligible, excluding subjects with congestive heart failure, coronary artery disease, diabetes mellitus and those taking cardioactive medications. We analyzed the low-frequency power (LF), high-frequency power (HF), LF/HF ratio, very low-frequency power (VLF) and total power (TP). Heritability analysis was done by studying correlations between siblings (n = 682, in 291 sibships, 517 pairs) and between spouse pairs (n = 206 pairs). Adjustments were made for sex, age, systolic and diastolic blood pressure, heart rate, coffee and alcohol intake. SAS procedure MIXED was used to estimate and test significance of correlation within sibling pairs and within spouse pairs. Results from separate models were combined to estimate the components of variance of each phenotype, i.e. variance attributable to measured covariates, additive genetic effects (heritability) and household effects. After adjusting for covariates, the correlations were consistently higher among siblings (0.21-0.26) compared to spouses (0.01-0.19). The measured covariates in general accounted for 13-40% of the total phenotypic variance, whereas genes accounted for 13-23% of the variation among HRV measures. Genetic factors contribute towards a substantial proportion of the variance in heart rate and HRV. Recognition of the genetic determinants of HRV may provide additional insight into the pathophysiology of the autonomic nervous system and offer clues toward its modulation.     

联合使用米氮平治疗抑郁症的临床研究

目的评价抗抑郁剂联合使用米氮平对治疗反应不佳的抑郁症的临床疗效和安全性。方法对81例单一抗抑郁剂治疗无效或部分反应的抑郁症添加米氮平或在原剂量不变的基础上治疗,共观察6周,使用汉密尔顿抑郁量表(HAMD17)评价疗效,并观察不良反应,记录不良事件。结果合并米氮平组和常规组分别脱落6例及4例,可供分析病例71例。结果显示观察终点时合并米氮平组(n=35)和常规组(n=36)HAMD17减分分别为(-11.5±5.2)分和(-6.1±4.8)分(t=4.53,P<0.01),有效率分别为66%及22%(χ2=13.65,P<0.01),合并米氮平组疗效明显增加,增效作用在治疗早期(1或2周)就有表现;合并米氮平组体重增加较多,常规组失眠多见。结论米氮平联合抗抑郁剂治疗抑郁症增加疗效,不良反应并未增多,增效作用较快,适合于治疗对单一抗抑郁剂治疗部分有效或未能缓解的抑郁症患者。     

急性脑血管病患者心率和QT间期的研究

目的了解急性脑血管病患者心率和QT间期的变化,为急性脑血管病的合理干预提供依据。方法检测246例急性脑出血(Ⅰ组)、251例急性脑梗死患者(Ⅱ组)和300例正常对照组的标准12导联心电图,观察心率和QT间期的变化。结果与正常对照组相比,Ⅰ组和Ⅱ组窦性心动过速的发生率显著增加,Ⅰ组增加更明显,而窦性心动过缓的发生率低于对照组;2组平均心室率明显增快,尤以急性脑出血组为甚。Ⅰ组和Ⅱ组平均QTc间期较对照组明显延长,且QTc间期延长的发生率显著增高。结论急性脑血管病患者平均心室率增快,QT间期延长。     

Heart rate time irreversibility is impaired in adolescent major depression

We aimed to study heart rate time irreversibility — a nonlinear qualitative characteristics of heart rate variability indicating complexity of cardiac autonomic control at rest and in response to physiological stress (orthostasis) in never-treated major depressive disorder (MDD) adolescent female patients.     

The role of genetics in suicide and the link with major depression and alcoholism

A clear genetic influence in suicide has been established. In addition, both the serotonergic and noradrenergic systems appear to have a role in suicide, mood disorders and alcoholism. This paper reviews some of the genes that may possibly be involved in suicide and their link to major depression and alcoholism. The genes that are reviewed act on various enzymes within the serotonergic and catecholaminergic systems. With further study, these entities may form a spectrum along the same disease process associated with variable expressivity of the responsible genes.     

Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures.

BACKGROUND: Studies have linked depression to sudden death and serious cardiovascular events in patients with preexisting cardiac illness. Recent studies have shown decreased vagal function in cardiac patients with depression and depressed patients without cardiac illness. METHODS: We compared 20-hour, sleeping, and awake heart period variability measures using spectral analysis, fractal dimension, and symbolic dynamics in two patient groups with major depression and ischemic heart disease (mean age 59-60 years) before and after 6 weeks of paroxetine or nortriptyline treatment. RESULTS: Spectral measures showed decreases in awake and sleeping total power (TP: 0.0-0.5 Hz), ultra low frequency power (ULF: 0-0.0033 Hz), very low frequency power (VLF: 0.0033-0.04 Hz), and low-frequency power (LF: 0.04-0.15 Hz) for nortriptyline condition and a decrease in high-frequency power (HF: 0.15-0.5 Hz) for the awake condition in patients who received nortriptyline. A measure of nonlinear complexity, WC-100, significantly increased after paroxetine during the awake condition. CONCLUSIONS: These findings suggest that nortriptyline has stronger vagolytic effects on cardiac autonomic function compared with paroxetine, which is in agreement with previous clinical and preclinical reports. Paroxetine may have some cardio-protective effects, especially in cardiac patients.     

噻奈普汀与阿米替林治疗抑郁症的对照研究

目的：验证噻奈普汀（Tianeptine)治疗抑郁症的临床疗效和安全性。方法：研究对象符合CCMD－2－R中抑郁发作的诊断标准,经安慰剂清洗3－7天后,被随机分入噻奈普汀治疗组和阿米替林治疗组,治疗剂量分别为37．5mg/日和150mg/日,疗程为6周。疗效评价采用汉密尔顿抑郁量表（HAMD,17项）,蒙哥马利抑郁量表（MADRS）,汉密尔顿焦虑量表（HAMA）和临床疗效总评量表（CGI）,安全性评价采用不良反应清单（AMDP－5）,于治疗前、治疗后第1、2、4、6周各评定一次,实验室检查包括血液常规、肝肾功能和ECG等。结果：共入组26例,噻奈普汀和阿米替林组各13例。根据HAMD减分率评价（减分率≥25％为有效）,6周末噻奈普汀组的HAMD总分平均下降73％,而阿米替林组为48％,判别有显著意义（P＝0．029）。两药的起效时间均在第2周。噻奈普汀的抗焦虑作用在第一周末即有显著效果,6周末的HAMA总分平均下降68％,显著高于阿米替林组的33％（P＝0．0196）。噻奈普汀的不良反应较阿米替林少而轻,结论：噻奈普汀具有肯定的抗抑郁和抗焦虑作用,6周末的临床疗效优于阿米替林,安全性高。     

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.