肝癌患者慢性应激的评价及其与患者预后相关性的初步研究

目的 检测肝癌患者心率变异(heart rate variability,HRV) 和应激指数水平,探索评估肝癌患者慢性应激水平的方法,初步探讨肝癌患者慢性应激状态与预后的相关性.方法 收集41例肝癌患者,利用HRV检测仪分别在术后5 d,3、6个月检测患者应激指数和HRV指标R-R间期标准差(standard deviations of normal-to-normal R-R intervals,SDNN) 、相邻R-R间期差值的均方根(root mean square standard deviations of R-R intervals,RMSSD) 、低频功率(low frequency,LF) 、高频功率(high frequency,HF) 的水平;分析HRV各指标与应激指数的相关性;并研究各应激指标与患者生存时间的关系.结果 HRV 4个指标分别与应激指数呈显著负相关(SDNN、RMSSD、LF、HF的r分别为- 0. 703、- 0. 674、- 0. 508、- 0. 707,P＜0. 01) .应激指数和HRV指标分别与肝癌患者预后相关: 应激指数高水平(≥52) 的患者无疾病生存期和总生存期均较低水平组(< 52) 明显缩短(P＜0. 01) .HRV 4个指标SDNN、RMSSD、LF、HF低水平的患者无疾病生存期分别较高水平组短(SDNN、RMSSD,P＜0. 01;LF、 HF,P＜0. 05) .4个HRV指标低水平组患者总生存期也较高水平组显著缩短(SDNN,P＜0. 05;RMSSD、LF、HF,P＜0. 01) .进一步分析发现应激指数和SDNN与肝癌患者术后复发情况明显相关(P = 0. 024,P = 0. 021) .结论 HRV水平较低的肝癌患者应激指数为高水平,这些应激指标能够评估患者慢性应激水平,证实慢性应激水平较高的肝癌患者术后复发率较高,总生存时间亦较短.

Assessment of chronic stress and its association with prognosis in hepatocellular carcinoma patients

Objective To evaluate chronic stress by detecting heart rate variability (HRV) and stress index in the patients with hepatocellular carcinoma (HCC), and primarily investigate the correlation of chronic stress and prognosis of HCC patients. Methods A total of 41 HCC patients undergoing total hepatectomy in First Affiliated Hospital of Army Medical University during 2012 to 2016 were enrolled in this study. Body-Checker device was used to detect the stress index, standard deviations of normal-to-normal R-R intervals (SDNN), root mean square standard deviations of R-R intervals (RMSSD), low frequency (LF) and high frequency (HF). The correlation of HRV indicators and stress index, and the relationship of stress indicators with survival time were analyzed. Results The 4 HRV indicators were negatively correlated with stress index respectively (SDNN: r =-0.703, RMSSD: r =-0.674, LF: r =-0.508, HF: r =-0.707, all P＜0.01). Stress index and HRV indicators were all related to the prognosis of HCC patients. The patients with high-level stress index (≥52) had shorter disease free survival (DFS) and overall survival(OS) than those with low-level (< 52) (all P＜0.01). The DFS of the patients with low-level HRV were shorter than the high-level group (SDNN and RMSSD: P＜0.01; LF and HF: P＜0.05). The patients with low-level HRV had shorter OS than those with high-level (SDNN: P＜0.05; RMSSD, LF and HF: P＜0.01). Further analysis indicated that stress index and SDNN were significantly correlated to the recurrence of HCC (P = 0.024, P = 0.021). Conclusion The HCC patients with low-level HRV have high stress indexes, which are effective in assessment of chronic stress. The patients with high-level chronic tress are prone to recurrence of HCC and to having shorter OS.