前庭性偏头痛患者的心率变异性特征分析

Characteristics of heart rate variability in patients with vestibular migraine

目的分析前庭性偏头痛(vestibular migraine,VM)患者的心率变异性(heart rate variability,HRV)特点,并对其可能机制进行探讨。方法选择2019年12月至2020年12月于郑州大学第二附属医院就诊的VM患者48例[男17例,女31例,年龄(36.2±9.2)岁]、偏头痛患者44例[男15例,女29例,年龄(34.4±9.0)岁]、同期健康体检者30例[男12例,女18例,年龄(34.6±6.5)岁]作为研究对象。对所有受试者进行动态心电图监测,分别从白天和夜晚两个时相分析各组的HRV特点。分析时域参数:全部窦性心搏RR间期标准差(SDNN)、相邻的RR间期差值的均方根(RMSSD)、相差大于50 ms的相邻RR间期占总数的百分比(pNN50)。分析频域参数:高频功率(HF)、低频功率(LF)、低频与高频功率的比值(LF/HF)。使用SPSS 26.0软件对数据进行统计学分析。结果在夜间,VM组和偏头痛组的RMSSD(F=6.694)、HF(F=9.434)较对照组降低,而LF/HF(F=16.049)和LF(F=9.434)较对照组升高,差异均有统计学意义(P<0.05或P<0.01),同时,VM组的LF升高程度较偏头痛组显著,差异有统计学意义(P<0.05)。在日间测量结果上,主要表现为前庭性偏头痛组LF较对照组升高,而RMSSD较对照组降低,差异有统计学意义(P值均<0.05)。结论VM患者存在以交感神经功能亢进,迷走神经功能减低为主要特征的自主神经功能紊乱,以夜间显著。此外,VM患者的自主神经功能紊乱较偏头痛更加严重。

Objective To analyze the characteristics of heart rate variability(HRV)in patients with vestibular migraine(VM)and to explore its possible mechanism.Methods Forty-eight patients with VM[17 males and 31 females,age(36.2±9.2)years],44 patients with migraine[15 males and 29 females,age(34.4±9.0)years],and 30 patients with health check-ups during the same period[12 males and 18 females,age(34.6±6.5)years old]were selected as study subjects.Ambulatory ECG monitoring was performed in all subjects,and the HRV characteristics of each group were analyzed from both daytime and nighttime time phases.Time domain parameters were analyzed:standard deviation of normal to normal(SDNN),root mean square of successive differences(RMSSD),and percentage of normal to normal intervals differing by more than 50 ms(pNN50).The parameters in the frequency domain were analyzed:high frequency power(HF),low frequency power(LF),and the ratio of low frequency to high frequency power(LF/HF).Statistical analysis of the data was performed using SPSS 26.0 software.Results At night,RMSSD(F=6.694)and HF(F=9.434)were lower in the VM and migraine groups compared to the control group,while LF/HF(F=16.049)and LF(F=9.434)were elevated compared to the control group,with statistically significant differences(P<0.05 or P<0.01),while LF was significantly elevated in the VM group compared to the migraine group,with a statistically significant(P<0.05).On the daytime measurements,mainly LF was elevated in the vestibular migraine group compared with the control group,while RMSSD was decreased compared with the control group,with statistically significant differences(P<0.05).Conclusion Autonomic dysfunction characterized by sympathetic hyperfunction and vagal hypofunction is present in VM patients and is more pronounced at night.In addition,the degree of autonomic dysfunction may be more pronounced in VM patients than in migraine patients.