多发性硬化患者心率变异性变化及其临床意义

Heart rate variability changes in patients with multiple sclerosis and its clinical significance

目的探讨多发性硬化(MS)患者心率变异性变化及其临床意义。方法分别选取2010年10月至2012年10月武汉市第五医院神经内科收治的40例MS且无心血管自主神经功能障碍患者作为观察组以及30例健康志愿者作为对照组。同时对两组受检者均行24 h动态心电图监测,比较其心率变异性变化情况。统计两组随访1年的心血管自主神经功能障碍发生情况,比较观察组不同心血管自主神经功能障碍患者的心率变异性,并采用ROC曲线分析MS患者心率变异性对其心血管自主神经功能障碍的预测价值。结果与对照组比较,观察组患者检测1 h、6 h、12 h和24 h的全部窦性心搏RR间期(SDNN)、RR间期平均值标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)等心率变异性指标均降低,差异有统计学意义(P<0.05);随访1年,观察组患者发生心血管自主神经功能障碍者11例,占27.50%(11/40),高于对照组的6.67%(2/30),差异有统计学意义(P<0.05);合并心血管自主神经功能障碍的MS患者各心率变异性指标均低于无血管自主神经功能障碍的MS患者,差异有统计学意义(P<0.05);ROC曲线分析结果显示,各心率变异性指标联合预测其心血管自主神经功能障碍发生的价值良好,其中SDNN+SDANN+r MSSD+p NN50+HF+LF截断值为106.41 ms+76.85 ms+29.45 ms+12.78%+1 984.26 ms+842.41 ms时可同时取得较高的敏感度、特异度、阳性预测值及阴性预测值。结论 MS患者心率变异性降低且对其心血管自主神经功能障碍发生的预测价值良好,心率变异性指标可作为MS患者心血管自主神经功能障碍早期诊断参考指标之一。

Objective To study the heart rate variability changes in patients with multiple sclerosis and its clinical significance. Methods Forty patients with multiple sclerosis without cardiovascular autonomic dysfunction and 30 healthy volunteers treated in Department of Neurology in the Fifth Hospital of Wuhan from October 2010 to October2012 were respectively selected as observation group and control group. Both of the two groups had 24 h dynamic ECG monitoring at the same time, and heart rate variability of two groups were compared. Both of the two groups were followed up for 1 year, and occurrence of cardiovascular autonomic nerve dysfunction of the two groups was statistically analyzed. Heart rate variability of patients with or without cardiovascular autonomic nerve dysfunction in observation group were compared, and ROC curve was used to analyze the value of heart rate variability in predicting occurrence of cardiovascular autonomic nerve dysfunction of patients with multiple sclerosis. Results Compared with control group,standard deviation of NN intervals（SDNN）, standard deviation of the mean RR intervals（SDANN）, root mean square of successive differences（RMSSD） detected at 1 h, 6 h, 12 h and 24 h in observation group were all significantly reduced（P〈0.05）. During the follow-up of one year, cardiovascular autonomic dysfunction was recorded in 11 cases in the observation group（27.50%, 11/40） and in 2 cases in the control group（6.67%, 2/30）, P〈0.05. Heart rate variability index of patients with multiple sclerosis and cardiovascular autonomic nerve dysfunction were lower than that of patients with multiple sclerosis and without vascular autonomic nerve dysfunction（P〈0.05）. ROC curve analysis results showed that value of heart rate variability index unitedly forecasting cardiovascular autonomic nerve dysfunction occurs was high,and the highest sensitivity, specificity, positive predictive value and negative predictive value can be achieved at the same time with the SDNN＋SDANN＋r MSSD＋p NN50＋HF＋LF cutoff value as 106.41 ms＋76.85 ms＋29.45 ms＋12.78%＋1 984.26 ms＋842.41 ms. Conclusion Heart rate variability in patients with multiple sclerosis reduced and had good value in predicting cardiovascular autonomic nerve dysfunction. The heart rate variability indexes can be used as indicators for early diagnosis of cardiovascular autonomic nerve dysfunction in patients with multiple sclerosis.