Autonomic Dysfunction Correlates with Clinical and Inflammatory Activity in Patients with Crohn's Disease
Autonomic Dysfunction Correlates with Clinical and Inflammatory Activity in Patients with Crohn's Disease
复制标题
DOI：
10.1097/mib.0000000000000508
复制
发表时间：
2015-10-01
影响因子：
4.9
通讯作者：
Beer-Gabel, Marc
中科院分区：
文献类型：
--
作者：
Engel, Tal;Ben-Horin, Shomron;Beer-Gabel, Marc
背景：自主神经功能障碍与克罗恩病（CD）有关。我们的目的是研究心率变异性（HRV）作为CD患者可能的自主神经失衡的标志。方法：30名CD患者和30名年龄和性别匹配的健康对照者参加了一项前瞻性队列研究，并进行了HRV研究。焦虑水平采用STAI问卷评分，CD临床活动采用Harvey-Bradshaw指数评估。对所有参与者进行了包括炎症标志物在内的血液检查。结果：与对照组相比，CD组的平均血压（85.51 11.07 mm Hg, 91.51 +/- 6.99, P = 0.015）和白蛋白均降低，CRP和IL-6均显著升高（P < 0.002）。甚低频功率和低频功率分量的平均HRV值在CD受试者中显著降低（P分别为0.038和0.027），表明交感音占优势。CD患者的状态焦虑（P = 0.001）和特质焦虑（P < 0.0001）的焦虑水平得分均显著高于CD患者。然而，活动性疾病患者的焦虑评分与缓解期患者相似，但BMI、白蛋白水平、CRP和IL-6水平均显著低于缓解期患者（所有比较均P < 0.05）。此外，尽管焦虑评分相似，但活动性疾病患者的脉搏率更高（P = 0.02）， HRV指数更低，这与白蛋白水平相关（r = 0.7, P = 0.001）。结论：虽然与对照组相比，乳糜泻患者有更高的焦虑水平，但他们表现出与焦虑状态无关的低HRV，与疾病活动和炎症标志物直接相关。这些观察结果表明，与活动性炎症相关的自主神经功能的内在不平衡。
Background:Autonomic dysfunction has been implicated in Crohn's disease (CD). We aimed to investigate heart rate variability (HRV) as a marker of possible autonomic imbalance in patients with CD.Methods:Thirty patients with CD and 30 age- and gender-matched healthy controls were enrolled in a prospective cohort study and underwent HRV study. Anxiety level was scored using the STAI questionnaire and CD clinical activity was assessed by Harvey-Bradshaw index. Blood tests including inflammatory markers were obtained for all participants.Results:CD subjects had lower mean blood pressure (85.51 11.07 mm Hg, 91.51 +/- 6.99, P = 0.015) and albumin and significantly higher CRP and IL-6 compared with controls (P < 0.002 for all comparisons). Mean HRV values of very low-frequency power and low-frequency power components were significantly lower among CD subjects (P = 0.038 and 0.027, respectively), implying a predominant sympathetic tone. Anxiety level scores were significantly higher among patients with CD for both state anxiety (P = 0.001) and trait anxiety (P < 0.0001). However, patients with active disease had similar anxiety scores as patients in remission, yet had a significantly lower BMI, lower albumin level, and higher CRP and IL-6 levels (P < 0.05 for all comparisons). Moreover, despite similar anxiety scores, patients with active disease had higher pulse rate (P = 0.02) and lower HRV indexes, which correlated with albumin levels(r = 0.7, P = 0.001).Conclusions:Although patients with CD have higher anxiety levels compared with controls, they exhibit depressed HRV independent of this anxiety state and in direct correlation with disease activity and inflammatory markers. These observations suggest an inherent imbalance of autonomic function associated with active inflammation.