焦虑症患者心率变异性的相关研究

目的:探讨焦虑症患者心率变异性异常的一些相关影响因素。方法:选取焦虑症患者(焦虑症组)80例和健康志愿者(正常对照组)80名完成一般情况问卷及病史问卷、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)评定,同时采用24小时动态心电图记录器测定两组被试心率变异性(HRV)指标,并进行比较。结果:焦虑症组平均心率显著高于正常对照组(t=6.79,P<0.01)。焦虑症组HRV所有指标均低于对照组(P<0.05或P<0.01),其中SDNN、RMSSD、PNN50、HF及LF/HF与对照组相比差异有统计学意义(t分别=-11.95,-5.34,-4.79,-2.69,-2.93;P均<0.01)。不同性别(F=5.500)、不同年龄段(F=270.39)两组被试平均心率指标差异有统计学意义(P<0.05或P<0.01)。结论:焦虑症患者自主神经功能紊乱与性别、年龄有关。     

焦虑症与心率变异性的相关研究

焦虑症不仅有焦虑、紧张、恐惧等情绪障碍,而且还伴有自主神经系统的症状,临床发现许多焦虑症患者以心脏自主神经系统功能紊乱症状最为突出。本文对广泛性焦虑障碍和惊恐障碍患者的心脏自主神经紊乱的临床症状、发病机制与心率变异性这一指标的相关研究进行综述。     

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。     

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。     

焦虑症与心脏自主神经功能紊乱的相关研究

近年来,焦虑症对人体健康的影响越来越为人们关注。据统计,现症患病率是7.9%[1]。焦虑症不仅伴有焦虑、紧张、恐惧等情绪障碍,而且还伴有自主神经系统的症状,临床发现许多焦虑症患者以心脏自主神经系统功能紊乱症状最为突出,国内外对此做过许多的相关研究。本文从生理学、心理学角度阐述了焦虑症与心脏自主神经功能之间的相关机制,并对心脏自主神经功能目前常用的评定指标做了总结,为今后焦虑症的诊断、治疗提供了理论依据。     

心率变异性指标在急性脊髓损伤患者自主神经功能中的评估价值

目的应用心率变异性(HRV)评价急性脊髓损伤(SCI)后自主神经功能(ANS)。方法纳入符合标准的46例SCI的患者,根据其SCI的平面分为高位损伤(C_1～T_5)组和低位损伤组(T_6～T_(12))组。高位损伤组24例,其中新入院12例,康复训练后12例;低位损伤组22例,其中新入院11例,康复训练后11例。另根据美国脊髓损伤学会(ASIA)残损分级再次对患者进行分组,将其分为完全性SCI组和不完全性SCI组。其中完全性SCI组19例(新入院10例,康复训练后9例);不完全性SCI组27例(新入院13例,综合康复训练后14例)。收集新入院患者(受伤3～7 d)、康复训练后(康复训练3周,受伤后27～33 d)24 h动态心电图,分析指标:高频功率(HF)、低频功率(LF)、LF/HF、超过50 ms的个数占总(PNN50)、差值均方的平方根(rMSSD)、均值标准差(SDANN)。结果新入院患者中,高位损伤组较低位损伤组LF/HF下降显著,高频指标增高更显著,完全性SCI组与不完全SCI组伤相比,HRV无论高频部分还是低频部分都不同程度降低(P0.05);康复训练后高位损伤组与低位损伤组相比,LF/HF显著降低;完全性SCI组与不完全性SCI组相比,HRV无论高频部分还是低频部分不同程度降低;康复训练后与新入院对比,高位损伤组SDANN显著升高,不完全性SCI组SDANN显著升高,但其他各项指标变化不显著。结论急性期SCI损伤的平面越高,损伤程度越严重,此时患者自主神经系统受损越发严重;伤后1个月时完全性SCI自主神经功能恢复较差,而损伤平面较高的患者难达到交感迷走平衡,损伤平面高的患者较损伤平面低的患者副交感神经更占优势,不完全性SCI患者自主神经恢复优于较完全性SCI患者。     

心率变异性指标在区分单相、双相抑郁中的应用

目的 探讨心率变异性指标在区分单相抑郁和双相抑郁中的应用价值。方法 采用横断 面调查法,选取2020年1月—2023年6月于上海市精神卫生中心就诊的处于抑郁发作期的126例单相抑 郁患者为单相抑郁组、247 例双相抑郁患者为双相抑郁组。采用临床资料调查表、心率变异性指标比较 两组患者的临床资料和心率变异的差异。采用 Logistic 回归分析,控制年龄、性别和体重指数潜在混淆 变量,评估心率变异性指标在区分单相抑郁和双相抑郁中的判别能力,并构建个体模型预测概率变量。 结果 双相抑郁患者的体重指数高于单相抑郁患者,差异有统计学意义（t=-2.798,P＜ 0.05）。两组患 者重搏弹性指数和低频功率 / 高频功率差异无统计学意义（P＞ 0.05）,双相抑郁组患者心率变异性指标 （SDNN、pNN50、极低频功率、低频功率、高频功率、总功率）低于单相抑郁组患者,心血管特征指标（心率、 射血弹性指数、重搏扩张指数）高于单相抑郁组患者,差异均有统计学意义（均P＜0.05）。控制协变量（年 龄、性别和体重指数）后,两组患者低频功率 / 高频功率比较,差异无统计学意义（P＞ 0.05）,双相抑郁组 患者心率变异性其他各指标（SDNN、pNN50、极低频功率、低频功率、高频功率、总功率）低于单相抑郁 组患者,差异均有统计学意义（均P＜ 0.001）。Logistic 回归分析显示,除年龄、性别和低频功率 / 高频功 率外,其他变量指标在各自的区分模型中差异均有统计学意义（OR=0.959～1.097,95%CI：0.937～1.166, P＜ 0.05）;体重指数在所有区分模型中差异均有统计学意义（OR=1.076～1.097,95%CI：1.010～1.166, P＜ 0.05）。结论 心率变异性指标可能成为区分单相抑郁和双相抑郁的心理生理学生物标志物。     

改进排列熵方法及其在心率变异复杂度分析中的应用*☆◆

背景：心率变异信号蕴含着有关心血管系统调节的重要信息,很多非线性动力学方法和复杂性测度已被用于心率变异信号的分析。排列熵是近年提出的一种新的熵测度,具有概念简单,计算简洁等优点,在很多领域得到了广泛的应用。 目的：针对心率变异信号特点,对排列熵方法进行等值状态处理的改进,在排列符号序列中以相同符号代表等值状态;通过临床数据实验,考察改进排列熵方法在心率变异性信号分析中的应用价值。 方法：心率变异信号取自PhysioNet中MIT-BIH Fantasia数据库和BIDMC Congestive Heart Failure(CHF)数据库,分为年轻健康人、老年健康人和充血性心力衰竭患者3组。应用排列熵和改进排列熵方法对3组数据分别进行分析,通过单因素方差分析和t检验对结果进行统计分析。 结果与结论：排列熵的两种等值状态处理方法均无法对3组数据作出有效区分,尤其是年轻健康人和老年健康人两组数据;而改进排列熵方法可以对3组数据作出非常有效的区分,即使是在短时的心率变异性分析中(500个RR间期,6~7 min)。提示改进排列熵方法可以有效提高生理、病理心率变异信号的区分度,比排列熵方法更有效的表征心率变异信号的复杂性。     

糖尿病合并冠心病、脑卒中患者心率变异性频域分析

对48例糖尿病合并冠心病,脑卒中患者进行心率变异性频域分析（HRSA）与30例糖尿病无合并症组对照,发现观察组中HRSA频谱成分明显长于正常组,HRSA是早期发现糖尿病合并冠心病,脑卒中患者植物神经功能紊乱的敏感方法。     

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.     

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。     

State-related differences in heart rate variability in bipolar disorder

Heart rate variability (HRV) is a validated measure of sympato-vagal balance in the autonomic nervous system. HRV appears decreased in patients with bipolar disorder (BD) compared with healthy individuals, but the extent of state-related alterations has been sparingly investigated. The present study examined differences in HRV between affective states in BD.A heart rate and movement sensor weighing 8 g collected average acceleration, heart rate and the two slowest and fastest heart beats (of the most recent 16 beats) every 30 s over a period of at least three consecutive weekdays and nights in a prospective longitudinal design from a total of 31 different affective states in 16 outpatients with BD. A proxy measure of HRV was calculated as the difference between the second-shortest and the second-longest inter-beat-interval collected during each of the epochs. Analyses were based on over 100.000 HRV data-points.In unadjusted analyses and in analyses adjusted for age, gender and heart rate, during a manic state HRV was increased by 18% compared with a depressed state (e^B = 1.18, 95% CI: 1.16–1.20, p < 0.001) and increased by 17% compared with a euthymic state (e^B = 1.17, 95% CI: 1.15–1.19, p < 0.001), whereas there was no difference between a depressive state and a euthymic state (e^B = 0.98, 95% CI: 0.96–1.00, p = 0.12). Further inclusion of BMI as a covariate did not alter any of the associations.HRV appears to be altered in a state-dependent manner in bipolar disorder and could represent a candidate state marker. Further studies with larger sample sizes are warranted.     

强迫症患者治疗前后心率变异性的频谱分析

目的 观察强迫症患者治疗前后心率变异性的改变.方法 符合CCMD-3强迫症诊断标准的68例患者口服马来酸氟伏沙明治疗,治疗前后进行心率变异性检查.结果 强迫症组治疗前的心率变异性总功率(TP)、高频功率(HF)指标均低于正常对照组,差异有统计学意义(P＜0.01),低频功率/高频功率强迫症组治疗前高于正常对照组,差异具...     

Threat-induced autonomic dysregulation in panic disorder evidenced by heart rate variability measures

Objective

The objective was to compare autonomic response to threatening stimuli between patients with panic disorder (PD) and healthy volunteers by using 5-min recordings of heart rate variability (HRV).

Methods

Twenty-seven patients with PD and 20 healthy controls were recruited. The first 5-min measurement of HRV was conducted at resting state. HRV measurement during threatening stimuli was conducted while participants were viewing 15 threatening pictures. Spectral analyses measures included high-frequency (HF; 0.15–0.4 HZ) component, low-frequency (LF; 0.04–0.15 Hz) component and LF/HF ratio.

Results

There was no significant HRV difference between the two groups at the resting state. During threatening stimuli, the PD group had significantly higher LF power and LF/HF ratio and significantly lower HF power than the healthy controls (for all, P< .01). A two-way analysis of variance was employed to determine the effect of group (patient and control) and condition (threatening and resting) on all three HRV measures. The analysis showed a significant main effect of group (F= 12.21; P< .01), condition (F= 14.21; P< .001) and interaction effect between group and condition (F= 4.83; P< .05) on LF/HF ratio.

Conclusions

The findings from the present study suggest that patients with PD exhibit a sympathetic predominance when faced with threatening stimuli compared with normal control subjects.     

The effect of aging and severity of sleep apnea on heart rate variability indices in obstructive sleep apnea syndrome

Objective

This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS).

Methods

176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices.

Results

The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis.

Conclusion

The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.     

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。     

快眼动睡眠行为障碍与心率变异性的关系研究

目的 探讨快眼动睡眠行为障碍(REM sleep behavior disorder,RBD)患者的心率变异指标,评估心脏自主神经功能的情况。方法 本研究选取2016年1月-2017年12月就诊于新疆医科大学第五附属医院神经内科门诊及住院的患者,并经视频多导睡眠监测(vPSG)且符合RBD诊断标准的患者30例作为病例组,其中特发性RBD 5例,帕金森病(PD)伴RBD 12例,多系统萎缩(MSA)伴RBD 8例,进行性核上性麻痹(PSP)伴RBD 5例。另选健康对照者25例。使用动态心电图的心率变异(HRV)分析来定量测定30例RBD患者和25例健康对照者的时域及频域分析指标,比较2组的HRV情况。结果 病例组患者的时域分析指标如NN间期标准差(SDNN)、每5 min NN间期标准差(SDANN)、每5 min NN间期标准差的均值(ASDNN)及相邻NN间期差值的均方根(rMSSD)均较健康对照组低(P均<0.05)。病例组频域分析指标低频功率(LF)、高频功率(HF)、LF/HF均较健康对照组低(P均<0.05)。结论 RBD患者存在不同程度的HRV下降情况,提示心脏自主神经功能损害。     

Heart rate variability in bipolar disorder: A systematic review and meta-analysis

BackgroundHeart rate variability (HRV) has been suggested reduced in bipolar disorder (BD) compared with healthy individuals (HC). This meta-analysis investigated: HRV differences in BD compared with HC, major depressive disorder or schizophrenia; HRV differences between affective states; HRV changes from mania/depression to euthymia; and HRV changes following interventions.MethodsA systematic review and meta-analysis reported according to the PRISMA guidelines was conducted. MEDLINE, Embase, PsycINFO, The Cochrane Library and Scopus were searched. A total of 15 articles comprising 2534 individuals were included.ResultsHRV was reduced in BD compared to HC (g = -1.77, 95% CI: −2.46; −1.09, P < 0.001, 10 comparisons, n = 1581). More recent publication year, larger study and higher study quality were associated with a smaller difference in HRV. Large between-study heterogeneity, low study quality, and lack of consideration of confounding factors in individual studies were observed.ConclusionsThis first meta-analysis of HRV in BD suggests that HRV is reduced in BD compared to HC. Heterogeneity and methodological issues limit the evidence. Future studies employing strict methodology are warranted.