慢性腰痛患者焦虑状态与心率变异相关性的研究

Correlation between anxiety and heart rate variability in patients with chronic low back pain

目的探讨慢性腰痛伴焦虑患者的心率变异性(heartratevariability,HRV)变化,焦虑严重程度与HRV各指标的相关性,以及心理疏导对HRV的影响。方法筛选76例慢性腰痛伴焦虑患者作为研究对象,与65例健康人群进行HRV各指标比较。采用Pearson相关性分析验证病例组汉密顿焦虑评分(hamilton anxiety scale,HAMA)与HRV的各指标相关性;观察病例组患者心理疏导前后HRV各指标的变化。结果与对照组比较,慢性腰痛伴焦虑患者HRV各指标(SDNN、RMSSD、PNN50、HF)显著降低,LF/HF比值显著增高。且该组患者HAMA总分与SDNN、RMSSD、PNN50、HF、LF/HF存在很强的相关性,相关系数r值分别为:-0.57,-0.62,-0.54,-0.73,0.71(P<0.01)。经心理疏导后,SDNN、RMSSD、PNN50、HF显著增加,LF/HF比值显著降低。结论慢性腰痛伴焦虑患者的HRV指标较健康者变化明显,反映其自主神经功能紊乱,且焦虑严重程度与HRV变化程度相关。心理疏导有利于慢性腰痛伴焦虑患者自主神经功能及HRV指标的改善。

Objective To investigate the changes of heart rate variability(HRV)in patients with chronic low back pain and anxiety,the correlation between severity of anxiety and HRV indicators,and the effect of psychological counseling on HRV.Methods A total of 76 patients with chronic low back pain and anxiety were selected as observation group,and 65 healthy people were selected as control group.The HRV indicators were compared between the two groups.Pearson correlation was used to analyze the correlation between the Hamilton anxiety scale(HAMA)score and HRV.The changes of HRV indicators before and after psychological counseling in the observation group were observed.Results Compared with the control group,HRV indicators(SDNN,RMSSD,PNN50 and HF)in patients with chronic low back pain and anxiety were significantly decreased,while LF/HF ratio was significantly increased.There was strong correlation between HAMA score and SDNN,RMSSD,PNN50,HF,LF/HF,and the correlation coefficients r were-0.57,-0.62,-0.54,-0.73,0.71,respectively(P<0.01).After psychological counseling,SDNN,RMSSD,PNN50,HF increased significantly,and LF/HF ratio decreased significantly.Conclusion The changes of HRV in patients with chronic low back pain and anxiety are more obvious than those in healthy subjects,which reflects the dysfunction of autonomic nervous system,and the severity of anxiety(HAMA score)is related to the changes of HRV.Psychological counseling is beneficial to the improvement of autonomic nervous function and HRV in patients with chronic low back pain and anxiety.