甲状腺功能亢进症与甲状腺功能减退症患者的自主神经功能状况分析

目的 通过对甲状腺功能亢进症(简称甲亢)和甲状腺功能减退症(简称甲减)患者心率变异性的分析,探讨两种疾病的自主神经功能状况.方法 对49例甲亢患者、25例甲减患者和40例健康者(对照)进行12导联同步24 h动态监测,计算机回放后采用人机对话方式剔除干扰,常规分析24 h心电图,计算24 h心率变异性,包括时域指标全部RR间期的标准差(SDNN)、相邻RR间期差值的均方根(RMSSD)]和频域指标极低频段功率(VLF)、低频段功率(LF)、高频段功率(HF)、低频段功率与高频段功率比值(LF/HF)].结果 甲亢组的时域指标SDNN(69.65±13.55)ms]、RMSSD(12.98±3.20)ms]明显低于对照组(136.07±11.95)、(29.70±5.85)ms],两组比较差异均有统计学意义(P＜0.01);频域指标HF(53.31±15.84)ms2]低于对照组(223.38±50.09)ms2],而VLF(1823.55±238.13)ms2]、LF(501.88±92.47)ms2]、LF/HF(5.89±1.15)均高于对照组(325.68±60.47)ms2、(405.60±51.41)ms2、2.14±0.56],两组比较差异均有统计学意义(P＜0.01).甲减组的时域指标SDNN(77.00±15.48)ms]、RMSSD(14.80±2.58)ms]也明显低于对照组(P＜0.01);频域指标HF(57.88±12.20)ms2]、VLF(251.48±24.67)ms2]、LF(128.68±43.78)ms2]均低于对照组(P＜0.01);LF/HF为1.83±0.63,与对照组比较,差异无统计学意义(P＞0.05).结论 甲亢患者表现为交感神经功能亢进,迷走神经功能低下;甲减患者表现为迷走神经、交感神经功能均减低.

Hyperthyroidism and primary hypothyroidism in patients with autonomic nerve function analysis

Objective To investigate autonomic nervous system(ANS)function of hyperthyroidism and hyperthyroidism by analyzing the heart rate variability(HRV)of patients with the diseases.Methods 12-synchronous dynamic 24-hour monitoring and man-machine dialogue were performed in 49 patients with hyperthyroidism,25 patients with hypothyroidism and 40 controls after removing interference,and 24-hour electrocardiogram wag analyzed.Heart rate variability indicators observed included 24-hour time-domain indexesstandard deviation of all experimental time RR(SDNN),root of mean square standard deviation from adjacent RR interval(RMSSD)]and 24-hour frequency domain indicatorsvery low frequency power(VLF),low-frequency power(LF),high frequency power(HF),low frequency power/high frequency power(LF/HF)].Results Indicators of time domain in hyperthyroidism group,such as SDNN(69.65±13.55)ms]and RMSSD(12.98±3.20)ms]were obviously lower than those of the control group(136.07±11.95),(29.70±5.85)ms],the differences being statistically significant (P＜0.01).Indicators of frequency domain HF(5331±15.84)msz]were lower than those of the control group (223.38±50.09)ms2],butVLF(1823.55±238.13)ms2],LF(501.88±92.47)ms2]and LF/HF(5.89±1.15)was higher compared with that in the control group,repectively(325.68±60.47)ms2,(405.60±5 1.41)ms2,2.14±0.56,P＜0.01).Among time domain indicators in hypothyroidism group,SDNN(77.00±15.48)ms]and RMSSD (14.80±2.58)ms]were also obviously lower than those in the control group(P＜0.01),the difference being significant statistically(P＜0.01).Frequency domain index HF(57.88±12.20)ms2],VLF(251.48±24.67)ms2],LF(128.68±43.78)ms2]also obviously lower than those in the control group(P＜0.01),but LF/HF,being 1.83±0.63,was in a normal range and did not significantly changed(P＞0.05). Conclusion In patients with hyperthyroidism both sympathetic and vagus nerves are hyperdynamic,while in patients with hypothyroidism,vagus nerves are hyperdynamic,while sympathetic nerve hypodynamic.