重症急性胰腺炎患者炎症反应与心率变异相关性研究

目的 探讨重症急性胰腺炎（SAP）患者急性期的心率变异性与血清炎症因子（TNF-α、IL-6）、降钙素原以及APACHEⅡ评分的关系.方法 收集2012年1月至2013年1月南京军区南京总医院普外科收治的41例SAP患者.入院24 h内采集5 min心电图数据进行心率变异性分析;同时采集患者血液,检测血清TNF-α、IL-6、降钙素原水平;入院24 h内行APACHEⅡ评分.分析心率变异性和上述各指标的相关性.结果 41例SAP患者中男性22例,女性19例,平均年龄47岁.其中胆源性20例,酒精性7例,高脂血症性9例,其他病因5例.血清TNF-α、IL-6、降钙素原水平分别为455 μg,/L、334μg/L、0.3 pg/L.APACHEⅡ评分为11 ～18分,平均14分.心率变异性的总功率（TP）、低频功率（LF）、高频功率（HF）分别为205.6、52.9、11.0 ms×ms,标准化低频功率（nLF）、标准化高频功率（nHF）分别为36.6、10.2 nU,低频高频功率比例（LF/HF）为3.4.nHF与血清TNF-α、IL-6、降钙素原水平及APACHEⅡ评分均呈正相关（r值分别为0.849、0761、0.480、0.346,P＜0.01或＜0.05）.LF/HF与血清TNF-α、IL-6、降钙素原水平均呈负相关（r值分别为-0.525、-0.708、-0.325,P＜0.01或＜0.05）,与APACHEⅡ评分无相关性.nLF与血清TNF-α、IL-6、降钙素原水平及APACHEⅡ评分均无相关性.结论 SAP患者血清TNF-α、IL-6、降钙素原水平与心率变异性密切相关.

Correlation between heart rate variability and inflammatory response in severe acute pancreatitis patients

Objective To evaluate the relationship between heart rate variability （HRV） and serum inflammatory cytokines （TNF-α,IL-6）,procalcitonin （PCT） and acute physiology and chronic health evaluation （APACHE） Ⅱ score in severe acute pancreatitis （SAP） patients.Methods Forty-one SAP patients admitted to Department of General Surgery,Department of General Surgery,General Hospital of Nanjing Military Area Command within 72 hours of symptoms onset were included in this study.Five-minite ECG signals were obtained within 24 h of admission for HRV analyses.At the same time,blood sample were obtained,then TNF-α,IL-6,PCT were determined.APACHE Ⅱ score were recorded within 24 h of admission.Results Among the 41 SAP patients,there were 22 male and 19 female with a median age of 47 years old.The etiologies were as follows,20 biliary cases,7 alcoholic cases,9 hyperlipidemia cases and 5 other cases.The serum levels of TNF-α,IL-6,PCT were 455 μg/L （301.5-790.0 μg/L）,334 μg/L（206.5-735.0 μg/L）,0.3 pg/L（0.1-1.2 pg/L）.The median APACHE Ⅱ score was 14 （range 11-18）.The TP,LF,HF of HRV was 205.6（84.9-921.0）,52.9（6.75-125.8）,11.0（4.1-40.9） （ms × ms） ; and the nLF,nHF was 36.6 （13.7-64.3）,10.2 （4.2-25.0） nu,while the LF/HF was 3.4 （1.7-6.8）.The level of nHF was positively correlated with TNF-α,IL-6,PCT（r =0.849,0761,0.480,p 〈 0.01）.The level of LE/HF was negatively correlated with TNF-α,IL-6,PCT（r =-0.525,-0.708,-0.325,p 〈 0.01 or 0.05）.nHF was positively correlated with APACHE Ⅱ score （r =0.346,P 〈 0.05）.However,LF/HF was not correlated with APACHE Ⅱ score.nLF was not correlated with other parameters.Conclusions Heart rate variability is closely correlated with TNF-α,IL-6 and PCT.