心率变异性与脑白质高信号严重程度的相关性分析

Correlation between Heart Rate Variability and White Matter Hyperintensity

背景脑白质高信号(WMH)是老年人颅脑影像学检查中最为常见的缺血性表现,可导致老年人认知功能下降、脑卒中风险增加、抑郁、排尿排便障碍,是老年人残疾、独立生活能力下降的重要原因,给社会及家庭造成极大的负担,因而其早期发现和干预尤为重要。目的探讨心率变异性(HRV)与WMH严重程度的相关性。方法选取2018—2020年于郑州大学第二附属医院神经内科住院的WMH患者248例为研究对象。收集患者一般资料、HRV参数。根据Fazekas量表总分,将患者分为三组:无或轻度WMH组(Fazekas量表总分为0~2分,97例)、中度WMH组(Fazekas量表总分为3~4分,104例)、重度WMH组(Fazekas量表总分为5~6分,47例)。WMH严重程度影响因素分析采用有序Logistic回归分析;HRV参数与WMH严重程度的相关性分析采用Spearman秩相关分析。结果重度WMH组全程每5分钟正常RR间期标准差的平均值(SDNNindex)、相邻正常RR间期相差超过50 ms的心搏数占总窦性心搏数的百分比(PNN50)低于无或轻度WMH组、中度WMH组(P<0.05);中度WMH组、重度WMH组相邻正常RR间期差值的均方根(rMSSD)、低频功率(LF)低于无或轻度WMH组(P<0.05);重度WMH组高频功率(HF)低于无或轻度WMH组(P<0.05)。有序Logistic回归分析结果显示,rMSSD是WMH严重程度的影响因素〔OR=0.987,95%CI(0.978,0.997),P<0.05〕;校正性别、年龄、高血压病史、糖尿病病史可能影响HRV或WMH严重程度的因素后,结果仍显示,rMSSD是WMH严重程度的影响因素〔OR=0.987,95%CI(0.977,0.997),P<0.05〕。Spearman秩相关分析结果显示,SDNNindex、rMSSD、PNN50、LF、HF与WMH严重程度呈负相关(r_(s)值分别为-0.232、-0.243、-0.167、-0.147、-0.151,P值均<0.05)。结论HRV参数中的SDNNindex、rMSSD、PNN50、LF、HF与WMH严重程度呈负相关,自主神经功能障碍可能参与了WMH的发生。

Background White matter hyperintensity(WMH)is the most common ischemic manifestation in brain imaging examination of the elderly,which can lead to the decline of cognitive ability,increased risk of stroke,depression,dysuria and defecation.It is an important reason for the disability and the decline of independent living ability of the elderly,and cause great burden to society and family.Therefore,its early detection and intervention are particularly important.Objective To explore the correlation between heart rate variability(HRV)and WMH.Methods A total of 248 patients with WMH admitted to the Second Affiliated Hospital of Zhengzhou University from 2018 to 2020 were selected as the research object.General data and HRV parameters of all patients were collected.According to the total score of Fazekas scale,the patients were divided into three groups:no or mild WMH group(Fazekas total score was 0-2,97 cases),moderate WMH group(Fazekas total score was 3-4,104 cases),severe WMH group(Fazekas total score was 5-6,47 cases).The ordinal Logistic regression analysis was used to explore the influencing factors of WMH severity.Spearman rank correlation analysis was used to explore the correlation between HRV parameters and WMH severity.Results The mean of the standard deviation of all normal RR intervals for 5-minute segments(SDNNindex)and percentage difference between adjacent normal-to-normal intervals that are greater than 50 ms (PNN50)in the severe WMH group were lower than those in the no or mild WMH group and the moderate WMH group( P<0.05).The root mean square of the successive normal sinus R-R interval difference(rMSSD)and low frequency power(LF)in themoderate WMH group and the severe WMH group were lower than those in the no or mild WMH group(P < 0.05).The highfrequency power(HF)of severe WMH group was lower than that of no or mild WMH group(P < 0.05).The results of ordinalLogistic regression analysis showed that,rMSSD was the influencing factor of WMH severity〔OR=0.987,95%CI( 0.978,0.997),P < 0.05〕;after adjusting for factors that may affect the severity of HRV or WMH by gender,age,history of hypertension,and diabetes,the results still showed that rMSSD was the influencing factor of WMH severity〔OR=0.987,95%CI(0.977,0.997),P < 0.05〕.Spearman rank correlation analysis showed that,SDNNindex,rMSSD,PNN50,LF,HF werenegatively correlated with the severity of WMH(r_(s) values were -0.232,-0.243,-0.167,-0.147,-0.151,respectively,P values were all < 0.05).Conclusion SDNNindex,rMSSD,PNN50,LF,HF of HRV parameters are negatively correlatedwith the severity of WMH,and autonomic dysfunction may be involved in the occurrence of WMH.