复发及病程对抑郁症患者心率变异性的影响研究  

Influence of Relapse and Disease Duration on Heart Rate Variability of Patients With Depressive Disorder

作　　者：王军[1] 朱文娴[1] 柳艳松[2] 张付全[2] 周振和[1] 

机构地区：[1]江苏省无锡市精神卫生中心临床精神科,214151 [2]江苏省无锡市精神卫生中心临床心理科,214151

出　　处：《中国全科医学》2015年第24期2881-2885,共5页Chinese General Practice

基　　金：南京医科大学科技发展基金面上项目(2013NJMU205)

摘　　要：目的比较首发抑郁症与复发抑郁症患者心率变异性(HRV)的差异,探讨复发及病程对抑郁症患者HRV的影响。方法选取2012年10月—2014年9月无锡市精神卫生中心有偿招募的抑郁症患者81例,根据其实际病情分为首发抑郁症组(首发组,35例)和复发抑郁症组(复发组,46例)。同时有偿招募健康志愿者43例作为对照组。收集受试者临床资料,并行24 h动态心电图检测,分析其HRV,采用协方差分析比较3组时域指标全部正常RR间期标准差(SDNN)、相邻RR间期差值>50 ms的心搏数所占百分比(p NN50)及频域指标低频功率(LF)、高频功率(HF)的差异,并采用偏相关分析探索抑郁症患者病程与各HRV指标间的相关性。结果首发组病程短于复发组(P<0.05)。交互作用检验显示,HRV指标数据均满足协方差分析的平行性假设(SDNN:F交互=1.234,P交互=0.301;p NN50:F交互=0.382,P交互=0.766;LF:F交互=1.243,P交互=0.297;HF:F交互=1.071,P交互=0.364)。3组LF和HF比较,差异均无统计学意义(P>0.05);3组SDNN和p NN50比较,差异均有统计学意义(P<0.05);其中,首发组和复发组SDNN和p NN50均低于对照组,复发组SDNN低于首发组(P<0.05)。对抑郁症患者(首发组+复发组)进行以年龄、BMI、汉密尔顿焦虑量表(HAMA)评分及汉密尔顿抑郁量表(HAMD)评分为控制变量的偏相关分析,结果显示,复发组患者病程与SDNN、HF呈负相关(R=-0.372、-0.261,P=0.001、0.022),与p NN50呈边缘负相关(R=-0.224,P=0.050),与LF无直线相关性(R=-0.076,P=0.513)。结论抑郁症患者存在HRV降低的特点,复发者比首发者HRV更低,且患者病程与SDNN、HF呈负相关,提示抑郁症复发及病程延长会加重自主神经功能紊乱。Objective To compare heart rate variability （HRV） between patients with first - episode depression and patients with recurrent depression and investigate the influence of relapse and disease course of depression on HRV. Methods We recruited 81 depressive patients with payment from Wuxi Mental Health Center from October 2012 to September 2014. These patients were divided into two groups ： first - episode group （ n = 35 ） and recurrent group （ n = 46）. We also recruited 43 healthy people with payment and assigned them into control group. Clinical data of subjects were collected; 24 h dynamic electrocardiogram was undertaken, and HRV was analyzed; analysis of covariance was conducted to compare SDNN, pNN50, LF and HF among the three groups; partial correlation analysis was conducted to determine the correlation between disease duration of depression and HRV indicators. Results The first - episode group had shorter disease duration than the recurrent group （P 〈 0. 05 ）. The test on interaction effect showed that HRV indicators all satisfied the parallelism hypothesis of covariance analysis （SDNN： Fi ion =1.234, Pi ion =0.301; pNN50： Finteraction =0.382, Pinteraetion =0.766; LF： Fi io. =1.243, Pinteraction = = 0. 297 ; HF ： Finteraction = 1.071, Pinteraction = io, = 0. 364 ）. The three groups were not significantly different （ P 〉 0. 05 ） in LF and HF; the three groups were significantly different （ P 〈 0.05 ） in SDNN and pNN50 ; the first - episode group and recurrent group were lower （P 〈 0. 05） than the control group in SDNN and pNN50, and the recurrent group was lower （ P 〈0.05） than the first - episode group in SDNN. The partial correlation analysis on depressive patients （ first - episode and recurrent group） with age, BMI, HAMA score and HAMD score as the control variables showed the following results： （R = -0. 372, -0. 261 ; P =0. 001, 0. 022） and marginally negatively correlated with pNN50 （R = -0. 224, P =0. 050） and had no linear correlat

关 键 词：抑郁症 复发 病程 心率变异性 

分 类 号：R749.41[医药卫生—神经病学与精神病学]