胰腺癌病人心率变异性变化及其临床意义研究(附518例分析)

Clinical significance of heart rate variability change in pancreatic cancer patients:An analysis of 518 cases

目的探讨胰腺癌病人心率变异性(HRV)的变化及其在临床中的价值。方法回顾性分析2008年1月至2013年5月浙江大学医学院附属第二医院收治的518例胰腺癌病人临床资料。以性别、年龄、癌症分期及癌症是否远处转移分组,对比不同组内的HRV指标,包括全部正常窦性心搏间期的标准差(SDNN)和全部相邻RR间期之差的均方根(r RMSSD)。以SDNN=20 ms为界分为低HRV组和高HRV组,比较两组间C反应蛋白(CRP)及肿瘤直径的统计学意义。结果胰腺癌早期病人、胰腺癌未转移病人的HRV值分别高于胰腺癌晚期病人(P<0.001)及胰腺癌已转移病人(P=0.011)HRV值,并且在低HRV组中观察到CRP显著升高(P=0.008)。结论胰腺癌的恶性程度与HRV的水平变化有关,低HRV的病人预后较差,这可能与迷走神经兴奋抑制炎性反应的机制有关。

Objective To evaluate the clinical value of heart rate variability change in the patients with pancreatic cancer. Methods The clinical data of 518 cases of pancreatic cancer admitted from January 2008 to May 2013 in the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. The moderating effects of gender,age,cancer stages and distant metastasis on HRV including standard diviation of NN intervals （SDNN） and root mean square of successive differences（RMSSD）were examined. The statistical significance of C-ractiveprotein （CRP）and tumor diameter between low HRV group and high HRV group using the cut-off of SDNN=20ms were tested. Results HRV values in cancer patients with early stage was higher than those with advanced stages significantly （P〈0.001）. HRV values in cancer patients without metastasis had significant higher HRV than those with metastases （P=0.011）. CRP was higher in low HRV group than that in high HRV group（P=0.008）. Conclusion The later the stage of pancreatic cancer patients is,the more the index of HRV declines, which may be related to the mechanism that vagal nerve excitement inhibits inflammatory reaction.