Characterization of autonomic dysfunction in patients with irritable bowel syndrome by means of heart rate variability studies
Characterization of autonomic dysfunction in patients with irritable bowel syndrome by means of heart rate variability studies
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DOI：
10.1111/j.1572-0241.1999.00861.x
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发表时间：
1999-03-01
影响因子：
9.8
通讯作者：
Ghista, D
中科院分区：
文献类型：
--
作者：
Adeyemi, EOA;Desai, KD;Ghista, D
目的：我们的目的是通过心率变异性（HRV）研究来表征肠易激综合征（IBS）患者的自主神经功能障碍。方法：取35例患者（平均年龄39.1 +/- 9.5岁，M:F比= 2.9:1）和18例健康对照者（平均年龄38.2 +/- 6.5岁，M:F比= 2:1），分别采用仰卧、站立和深呼吸模式。利用快速傅里叶变换和自回归技术分析了极低（VLF, 0.0078 ~ 0.04 Hz）、低（LF, 0.04 ~ 0.14 Hz）和高（HF, 0.14 ~ 0.4 Hz）频段的HRV功率谱。结果：仰卧位时，IBS患者VLF功率谱密度（PSD）显著高于正常（3 vs 1.3次/分钟[bpm](2)/Hz, p < 0.01）。当从仰卧位变为站立位时，正常人（NC）在VLF中位psd升高（1.3 vs 12.8 bpm(2)/Hz）。p < 0.01)和LF（1.6 vs 6.1 bpm(2)/Hz, p < 0.01）波段，作为交感神经张力增加的标志，而中位HF psd（副交感神经张力）保持不变（每个1.8 bpm(2)/Hz, p = 0.8）。同样，IBS患者站立时VLF （3.04 vs 14.93 bpm(2)/Hz, p < 0.01）和LF (2.8 vs 8.7 bpm(2)/Hz, p < 0.01) PSD升高，但HF PSD也升高（从2.4到5.7 bpm(2)/Hz, p 0.04）。从站立模式到深呼吸模式，正常人的HF显著增加(从1.8 bpm(2)/Hz增加到10.3 bpm(2)/Hz。p < 0.001)和VLF显著降低（从12.8到2.2 bpm(2)/Hz, p < 0.01） psd。LF PSD降低不显著（从6.1降至5.6 bpm(2)/Hz, p = 0.6）。在IBS中，HF PSD保持不变（5.7 bpm(2)/Hz, p = 0.6），而LF PSD从8.7增加到24.2 bpm(2)/Hz （p < 0.0001）。VLF PSD降低（从14.9降至4.1 bpm(2)/Hz, P < 0.0001）。在IBS中，站立体位时交感迷走神经中位流出比显著低于正常体位（1.4 vs 2.8, p < 0.02），而深呼吸体位时交感迷走神经中位流出比显著高于正常体位（7.33 vs 0.42, p < 0.0001）。结论：IBS患者在体位应激时交感神经对心脏期的影响减弱，深呼吸时副交感神经调节减弱。[J] .胃肠病杂志，1999,94:816-823。(C) 1999 by Am。科尔。胃肠病学)。
OBJECTIVE: Our aim was to characterize autonomic dysfunction in patients with irritable bowel syndrome (IBS) using heart rate variability (HRV) studies.METHODS: EKG signals were obtained from 35 patients (mean age, 39.1 +/- 9.5 yr, M:F ratio = 2.9:1) and 18 healthy controls (mean age, 38.2 +/- 6.5 yr, M:F ratio = 2:1) in supine, standing, and deep-breathing modes. Fast Fourier transformation and autoregressive techniques were used to analyze the HRV power spectra in very low (VLF, 0.0078-0.04 Hz), low (LF, 0.04-0.14 Hz), and high (HF, 0.14-0.4 Hz) frequency bands.RESULTS: In the supine position, the VLF power spectral density (PSD) in IBS was significantly higher than normal (3 vs 1.3 beats per minute [bpm](2)/Hz, p < 0.01). On changing from the supine to standing position, the normals (NC) had raised median PSDs in the VLF (1.3 vs 12.8 bpm(2)/Hz. p < 0.01) and LF(1.6 vs 6.1 bpm(2)/Hz, p < 0.01) bands, as a sign of increased sympathetic tone, whereas the median HF PSDs (parasympathetic tone) remained unchanged (1.8 bpm(2)/Hz each, p = 0.8). Similarly, the IBS patients had increased VLF (3.04 vs 14.93 bpm(2)/Hz, p < 0.01) and LF (2.8 vs 8.7 bpm(2)/Hz, p < 0.01) PSDs on standing up, but the HF PSD was also raised (from 2.4 to 5.7 bpm(2)/Hz, p 0.04). On changing from standing to the deep-breathing mode, the normals had a significant increase in the HF (from 1.8 to 10.3 bpm(2)/Hz. p < 0.001) and a significant reduction of the VLF (from 12.8 to 2.2 bpm(2)/Hz, p < 0.01) PSDs. The reduction of the LF PSD was not significant (from 6.1 to 5.6 bpm(2)/Hz, p = 0.6). In IBS, HF PSD remained constant (5.7 bpm(2)/Hz each, p = 0.6), whereas the LF PSD increased from 8.7 to 24.2 bpm(2)/Hz (p < 0.0001). The VLF PSD was reduced (from 14.9 to 4.1 bpm(2)/Hz, P < 0.0001). In IBS, the median sympathovagal outflow ratio was significantly lower in the standing position (1.4 vs 2.8, p < 0.02) and higher in the deep-breathing mode (7.33 vs 0.42, p < 0.0001) than normal.CONCLUSIONS: IBS patients have reduced sympathetic influence on the heart period in response to orthostatic stress and diminished parasympathetic modulation during deep breathing. (Am J Gastroenterol 1999:94:816-823. (C) 1999 by Am. Coll. of Gastroenterology).