心率变异性与扩大的血管周围间隙脑部分布关系研究  

Relationship between Heart Rate Variability and Distribution of Enlarged Perivascular Spaces in the Brain

作　　者：周东杨 陈静[1] 路畅 白宏英[1] ZHOU Dongyang;CHEN Jing;LU Chang;BAI Hongying(Department of Neurology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院神经内科,河南省郑州市450000

出　　处：《中国全科医学》2023年第11期1348-1354,1368,共8页Chinese General Practice

基　　金：河南省医学科技攻关计划项目(LHGJ20210423)。

摘　　要：背景扩大的血管周围间隙(EPVS)与认知功能障碍、情感障碍、脑卒中及卒中后不良结局等密切相关,尽早发现并给予处理极为重要。目的探讨心率变异性(HRV)与EPVS脑部分布之间的关系。方法选取2020年1月至2022年5月在郑州大学第二附属医院神经内科住院治疗并完成24 h动态心电图监测和脑部核磁共振(MRI)的患者199例为研究对象。评估患者EPVS负荷,根据EPVS分数对基底节区EPVS(BG-EPVS)及半卵圆中心EPVS(CS-EPVS)严重程度进行分组:轻度BG-EPVS组(Potter评分1分,126例)、中度BG-EPVS组(Potter评分2分,46例)、重度BG-EPVS组(Potter评分3~4分,27例);轻度CS-EPVS组(Potter评分1分,131例)、中度CSEPVS组(Potter评分2分,45例)、重度CS-EPVS组(Potter评分3~4分,23例)。根据BG-EPVS与CS-EPVS数量划分EPVS优势模型:模型1(BG>CS,119例)、模型2(BG=CS,20例)、模型3(BG<CS,60例)。比较各组的一般资料与HRV指标,采用Spearman秩相关分析探讨HRV指标与EPVS的相关性,将单因素分析中有统计学意义的HRV指标纳入多因素Logistic回归分析探讨EPVS严重程度及优势模型的独立影响因素。结果轻、中、重度BGEPVS组患者年龄、目标区间内正常间隔连续差的均方根(rMSSD)、总功率(TP)比较,差异有统计学意义(P<0.05);其中重度BG-EPVS组年龄高于轻度BG-EPVS组(P<0.05),重度BG-EPVS组rMSSD、TP低于轻度BG-EPVS组(P<0.05)。Spearman秩相关分析结果显示,HRV指标中的rMSSD、>50 ms的相邻正常间隔的百分比(PNN50)、TP与BG-EPVS严重程度呈负相关(r_(s)=-0.357、-0.153、-0.169,P<0.05);目标区间内每5 min正常间隔标准差的平均值(SDNNindex)、rMSSD与EPVS优势模型呈正相关(r_(s)=0.155、0.262,P<0.05)。校正混杂因素后的多因素Logistic回归分析结果显示,rMSSD是BG-EPVS严重程度的独立影响因素〔OR=0.983,95%CI(0.972,0.994),P=0.002〕;rMSSD是EPVS优势模型的独立影响因素〔OR=1.017,95%CI(1.006,1.028),P=0.003〕。结论rMSSD分别与BG-Background The enlarged perivascular space(EPVS)is closely associated with cognitive dysfunction,affective disorder,stroke,and adverse outcomes after stroke.So early detection and treatment of EPVS are extremely important.Objective To investigate the relationship between heart rate variability(HRV)and the distribution of EPVS in the brain.Methods One hundred and ninety-nine inpatients with complete examination results of 24-hour ambulatory ECG and brain MRI were selected from Department of Neurology,the Second Affiliated Hospital of Zhengzhou University from January 2020 to May 2022.The sum of EPVS was assessed,and by the sum of EPVS(severity score of EPVS)in basal ganglia region(BG-EPVS),the patients were divided into 3 groups:mild BG-EPVS group〔visual PVS rating scale score developed by Potter(Potter score)=1,126 cases〕,moderate BG-EPVS group(Potter score=2,46 cases),severe BG-EPVS group(Potter score=3-4,27 cases),and by the sum of EPVS in centrum semiovale region(CS-EPVS),the patients were divided into another 3 groups:mild CS-EPVS group(Potter score=1,131 cases),moderate CS-EPVS group(Potter score=2,45 cases),severe CS-EPVS group(Potter score=3-4,23 cases).The dominance models were divided according to the number of BG-EPVS and CS-EPVS,model 1(BG>CS,119 cases),model 2(BG=CS,20 cases),model 3(BG<CS,60 cases).The general data and HRV indexes were compared among groups.Spearman correlation analysis was used to explore the correlation between HRV indexes and EPVS.Statistically different HRV indexes in the univariate analysis were included in a multivariate Logistic regression to screen those independently influencing EPVS severity score and dominance models.Results Age,the root mean square of successive differences of normal-to-normal(NN)intervals for period of interest(rMSSD)and total power(TP)were statistically different between 3 groups of BG-EPVS(P<0.05).Severe BG-EPVS group had older average age,and lower average rMSSD and TP than mild BG-EPVS group(P<0.05).Spearman correlation analysis showed that rMSSD

关 键 词：扩大的血管周围间隙 心率变异性 大脑小血管疾病 基底节区 目标区间内正常间隔连续差的均方根 自主神经系统 血脑屏障 

分 类 号：R743[医药卫生—神经病学与精神病学]