心率变异性与帕金森病病情进展的关系

Relationship between heart rate variability and Parkinson's disease progression

目的探讨心率变异性(HRV)与帕金森病(PD)病情进展的相关性。方法选取连云港市第二人民医院2020年1月至2022年5月收治的PD患者78例为研究对象,按Hoehn-Yahr(H&Y)分期将PD患者分为3个亚组:早期组(H&Y分期<2),中期组(2≤H&Y<3),晚期组(H&Y≥3)。另选取该院同期健康体检者66例为对照组。分别对各组进行动态心电图检查,对HRV的参数分析,并采用Spearman检验对HRV各参数与病程、H&Y分期进行相关性分析。结果PD组24 h全部窦性心律RR间期的标准值(SDNN)(94.76±21.65)、24 h内全部相邻窦性RR间期差值的均方根值(RMSSD)(23.41±8.67)、24 h内RR间期差值>50 ms的连续正常的RR间期数所占百分数(PNN50%)(3.50±4.32)、高频成分(HF)(96.57±53.84)、低频成分(LF)(124.92±82.43)均显著低于对照组[(115.65±13.31)、(32.48±8.08)、(5.61±5.25)、(109.11±39.51)、(143.95±72.77)](Z=-6.17、-6.22、-3.90、-2.14、-2.53,均P<0.05);早期、中期、晚期三组患者患病时间、H&Y分期、LED水平呈上升趋势(均P<0.05);晚期简易精神状态检查(MMSE)评分较早期升高(P<0.05),早中期、中晚期之间MMSE评分比较,差异均无统计学意义(均P>0.05)。与早期PD组SDNN(110.61±18.53)、LF(192.02±95.98)比较,中期的PD组SDNN(91.97±15.23)、LF(113.29±56.71)均显著降低(t=4.18、3.55,均P<0.01);晚期的PD组SDNN(80.90±21.03)、LF(68.10±44.86)较早中期均降低(t=4.88、2.23、5.54、3.26,均P<0.05)。PD组早期、中期、晚期三组间RMSSD、PNN50%、HF比较,差异均无统计学意义(均P>0.05)。SDNN、LF与PD组病程均呈负相关(r=-0.36、-0.37,均P<0.05),与H&Y分期呈负相关(r=-0.46、-0.49,均P<0.05)。结论PD患者交感神经功能障碍与PD的发病及进展密切相关,可反映病情的严重程度。

Objective To investigate the correlation between heart rate variability(HRV)and the progression of Parkinson's disease(PD).Methods A total of 78 patients with PD who received treatment at the Second People's Hospital of Lianyungang from January 2020 to May 2022 were included in this study.According to Hoehn-Yahr(H&Y)staging,patients with PD were divided into three subgroups:mild PD group(H&Y stage<2),moderate PD group(2≤H&Y<3),and advanced PD group(H&Y≥3).Another 66 healthy people who concurrently underwent physical examinations in the same hospital were included in the control group.A dynamic electrocardiogram examination was performed in each group for HRV analysis.The Spearman test was used to analyze the correlation between HRV parameters,disease course,and H&Y staging.Results Standard deviation of all sinus R-R intervals during 24 hours(SDNN),root mean square of successive RR interval differences during 24 hours(RMSSD),percentage normal-to-normal interval deviation greater than 50 ms(PNN50%)during 24 hours,high frequency component(HF),and low frequency component(LF)in the PD group were(94.76±21.65),(23.41±8.67),(3.50±4.32),(96.57±53.84),and(124.92±82.43),respectively,which were significantly lower than(115.65±13.31),(32.48±8.08),(5.61±5.25),(109.11±39.51),and(143.95±72.77)in the control group(Z=-6.17,-6.22,-3.90,-2.14,-2.53,all P<0.05).Disease duration,H&Y staging,and the LED level in the mild PD,moderate PD,and advanced PD groups showed an upward trend(all P<0.05).The Mini-Mental State Examination(MMSE)score in the advanced PD group was significantly higher than that in the mild PD group(P<0.05).There was no significant difference in MMSE score between the mild and moderate stages and between moderate and advanced stages(P>0.05).Both SDNN and LF in the mild PD group were(110.61±18.53)and(192.02±95.98),respectively,which were significantly lower than(91.97±15.23)and(113.29±56.71)in the moderate PD group(t=4.18,3.55,both P<0.01).SDNN and LF in the advanced PD group were(80.90±21.03)and(68.10±44.86)respectively,which were significantly lower than those in the moderate PD and advanced PD groups(t=4.88,2.23,5.54,3.26,all P<0.05).There were no significant differences in RMSSD,PNN50%,and HF among the mild PD,moderate PD,and advanced PD groups(all P>0.05).SDNN and LF were negatively correlated with PD course(r=-0.36,-0.37,both P<0.05)and H&Y staging(r=-0.46,-0.49,both P<0.05).Conclusion Sympathetic dysfunction in PD patients is closely related to the onset and progression of PD,and it can reflect the severity of the disease.