心率变异性对原发性震颤和早期震颤型帕金森病的诊断价值

Diagnostic value of heart rate variability to essential tremor and early-stage tremor-dominant Parkinson’s disease

目的研究心率变异性(HRV)对原发性震颤(ET)和早期震颤型帕金森病(PD)的诊断价值。方法对26例ET患者(ET组)、30例早期震颤型PD患者(早期震颤型PD组)和23例健康对照者(健康对照组)进行24 h ECG检查,比较HRV指标的差异。结果与健康对照组比较,早期震颤型PD组全程NN间期的标准差(SDNN)、相邻NN之差的均方根(RMSSD)、低频功率(LF)和高频功率(HF)显著降低(均P<0.01),LF/HF差异无统计学意义(P>0.05);ET组RMSSD显著降低(P<0.05),SDNN、LF、HF和LF/HF差异无统计学意义(均P>0.05)。与早期震颤型PD组比较,ET组SDNN、LF和HF均显著升高(均P<0.01),RMSSD、LF/HF差异无统计学意义(均P>0.05)。结论震颤型PD患者存在交感和迷走神经的双重损害,早期几乎所有的HRV参数均显著降低。HRV可能有助于区分震颤型PD及ET。

Objective To study the diagnostic value of heart rate variability(HRV)to essential tremor(ET)and early-stage tremor-dominant Parkinson’s disease(PD).Methods A 24 h ECG examination was performed on the 26 ET patients(ET group),30 early-stage tremor-dominant PD patients(early tremor PD group)and 23 healthy controls(healthy control group),and the HRV indicators were compared.Results Compared with those in healthy control group,the standard deviation of normal-to-normal intervals(SDNN),root mean square of successive differences in adjacent NN intervals(RMSSD),low frequency(LF)and high frequency(HF)in early tremor PD group were significantly lower(all P<0.01),LF/HF had no statistical significance(P>0.05);RMSSD in ET group was significantly lower(P<0.05),SDNN,LF,HF,LF/HF had no statistical significance(all P>0.05).Compared with those in early tremor PD group,SDNN,LF,HF in ET group were significantly higher(all P<0.01),RMSSD,LF/HF had no statistical significance(all P>0.05).Conclusions Tremor-dominant PD patients suffer of both sympathetic and vagus nerve insults,almost all HRV parameters decreased significantly in the early stage.HRV may help to distinguish tremor PD and ET.There is a diagnostic value of HRV between tremor PD and ET in the early stage.