路易体痴呆和帕金森病痴呆患者心率变异性的改变和影响因素

Heart rate variability and its influencing factors in patients with dementia with Lewy bodies and patients with Parkinson disease dementia

目的 比较路易体痴呆（DLB）和帕金森痴呆（PDD）心率变异性（HRV）的差异及相关影响因素. 方法 回顾性分析2010年1月至2017年12月于我院综合门诊和住院患者诊断的DLB患者30例,PDD患者41例;119例健康老年人为对照组.对DLB患者和PDD患者行24 h动态心电图监测,对比分析两组心率变异性（HRV）的指标,同时对DLB和PDD患者进行左旋多巴等效剂量换算、简易智力状态检查量表和蒙特利尔认知评估量表、Hoehn-Yahr分期和统一PD评定量表Ⅲ、ADCS日常生活能力量表评分,探讨HRV的影响因素. 结果 DLB组和PDD组HRV的时阈性指标全程NN间期的标准差对数（4.57±0.30）和（4.69±0.25）、频性指标总功率对数（7.45±0.64）和（7.41±0.58）、低频成分对数（5.46±1.07）和（5.58±0.77）较对照组（4.86±0.30）、（7.69±0.57）、（5.92±0.82）降低（F值为14.154、4.742、4.897,均P＜0.01）,而DLB患者相邻NN之差的均方根对数较对照组有下降,但PDD患者与对照组比较,差异无统计学意义（P＞0.05）,DLB和PDD患者高频成分与对照组差异无统计学意义（P＞0.05）,同时DLB患者和PDD患者所有HRV指标比较差异无统计学意义（P＞0.05）.相关分析结果显示,DLB和PDD患者HRV各指标与患者的认知水平、运动障碍程度、日常生活能力、PD药物的使用剂量均无相关（P＞0.05）. 结论 DLB患者和PDD患者存在相似的自主神经功能损害,这种损害与患者的病情严重程度无关.

Objective To compare the difference in heart rate variability （HRV）between patients with dementia with Lewy bodies（DLB）and those with Parkinson disease dementia（PDD）and to identify the influencing factors.Methods We retrospectively enrolled 30 patients with DLB（DLB group）and 41 patients with PDD（PDD group）at the outpatient and inpatient services of our hospital from January 2010 to December 2017 in this study,and further recruited 119 normal elderly individuals to serve as the control group.HRV was recorded with 24 h dynamic electrocardiogram and compared between the DLB group and the PDD group.Time domain measures including standard deviation of all normal to normal（NN）intervals（SDNN）and square root of the mean squared differences of successive N N intervals（rMSSD）and frequency domain measures including total power（TP）,low frequency（LF）,and high frequency（HF）were analyzed with a customized program.The levodopa equivalent dose （LED）,mini-mental state examination （MMSE）,Montreal Cognitive Assessment （MoCA）,Hoehn-Yahr stage（H-Y stage）and the unified Parkinson＇s disease rating scale Ⅲ （UPDRS Ⅲ）,and the Alzheimer＇s disease Cooperative Study-Activities of Daily Living scale（ADCS-ADL）were assessed in DLB and PDD patients to investigate the influencing factors.Results SDNN,TP,and LF in the DLB group and the PDD group were significantly lower than in the control group （F =14.154,4.742,4.897,P〈0.05）.Compared with the control group,rMSSD decreased in the DLB group,but had no significant difference in the PDD group（P〉0.05）.The DLB group and the PDD group did not differ in HF from the control group （P 〉 0.05）.There was no significant difference in any HRV indexes between DLB and PDD patients（P 〉0.05）.Correlation analysis showed no correlation of HRV with cognitive level（MMSE,MoCA）,motor disturbance degree （UPDRS Ⅲ,H-Yahr stage）,daily living ability（ADCS-ADL）,or dosage of anti-PD drugs （each P 〉 0.05）.Conclusions DLB and PDD patients present similar impairments in autonomic nervous system function,which are not associated with disease severity.