类风湿关节炎病人自主神经功能的临床观察

The clinical observation of autonomic nerve function in patients with rheumatoid arthritis

目的:观察类风湿关节炎(rheumatoid arthritis,RA)病人心率变异(heart rate variability,HRV)的变化,并探究其与疾病相关指标的关系。方法:根据纳入和排除标准选出RA病人71例为试验组,同时选取年龄、性别等基本信息相匹配的健康人80名为对照组,入院当天评估RA病人疼痛视觉模拟评分法(visual analogue scale,VAS)评分,疾病活动度评分(disease activity score,DAS28)及焦虑自评量表(self-rating anxiety scale,SAS),通过HRV检测仪获取所有受试对象HRV频域(very low frequency,VFL;low frequency,LF;high frequency,HF;total frequency,TP)及时域(standard deviation of all normal-to-normal QRS intervals,SDNN)参数,并于次日清晨空腹抽血检查RA病人炎症指标及相关自身抗体。结果:RA病人所有HRV参数均较对照组显著降低,疼痛及焦虑会进一步降低RA病人的HRV,RA病人RF与HF呈显著负相关,除VLF外其余HRV指标与VAS和DAS28呈负相关,所有HRV指标均与hs-CRP及ESR呈负相关。结论:RA病人存在自主神经功能的紊乱,HRV有助于对RA病人进行综合评估。

Objective:To observe the changes of heart rate variability(HRV)in patients with rheumatoid arthritis(RA)and to investigate the relationship between HRV and disease-related indexes.Methods:Seventy one patients with RA were selected as the experimental group according to the inclusion and exclusion criteria,and 80 healthy adults with matching basic information were selected as the control group.The visual analogue scale(VAS),disease activity score(DAS28)and self-rating anxiety scale(SAS)scores of RA patients were evaluated on the day of admission.All subjects HRV frequency domain(very low frequency,VFL;low frequency,LF;high frequency,HF;total frequency,TP)and frequency domain(standard deviation of all normal-to-normal QRS intervals,SDNN)parameters were obtained through the HRV detector.In the early morning of the following day,blood was drawn to check the inflammatory indexes and related autoantibodies of the RA patient.Results:All HRV parameters of RA patients were significantly lower than those of healthy control group.Pain and anxiety would further reduce the HRV of RA patients.RF and HF in RA patients were significantly negatively correlated.All HRV indicators except VLF were negatively correlated with VAS and DAS28,all HRV indexes were negatively correlated with hs-CRP and ESR.Conclusion:Autonomic dysfunction exists in RA patients,and HRV is useful for the comprehensive assessment of RA patients.