Lee Yi-Chia, Wang Hsiu-Po, Lin Lian-Yu, Lee Bai-Chin, Chiu Han-Mo, Wu Ming-Shiang, Chen Ming-Fong, Lin Jaw-Town
Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, Taiwan.
Auton Neurosci. 2004 Nov 30;116(1-2):39-45. doi: 10.1016/j.autneu.2004.08.007.
Autonomic nervous dysfunction has frequently been observed in patients with gastroesophageal reflux diseases (GERD) and impacts the pathogenesis of GERD. However, the characteristics that distinguish between GERD patients with different manifestations remain unknown.
To investigate the autonomic nervous function in subgroups of GERD patients.
Of the 164 participants in this study, 57 were healthy controls, 34 had non-erosive reflux disease (NERD), 40 had symptomatic esophagitis (SE), and 33 asymptomatic esophagitis (AE).
Resting autonomic activity was assessed by measuring the 5-min heart rate variability (HRV) and HRV indices including time-domain parameters (standard deviation of normal-to-normal intervals [SDNN] and root mean square of successive differences [RMSSD]) and frequency-domain parameters (low-frequency power [LF; 0.04-0.15 Hz], high-frequency power [HF; 0.15-0.4 Hz], and LF/HF power ratio). Mental stress was assessed by use of a self-reported questionnaire (Brief Symptom Rating Scale [BSRS]).
HF power was (ANOVA, p=0.041) but time-domain parameters, LF power, LF/HF power ratio, and BSRS parameters were not significantly different between the four groups. A higher HF power was found in examinees with NERD than in those with SE and AE (LSD methods: both p=0.02). When split into two groups (erosive vs. non-erosive), nearly all measures of autonomic tonus were significantly lower in the erosive than non-erosive group. Age and the presence of endoscopic esophagitis influenced the RMSSD and HF power results in the regression analysis. Mental stress or gender did not correlate with any HRV index.
In comparison with NERD subjects, autonomic tonus in patients with endoscopically confirmed esophagitis (even without symptom) is lower. This finding may suggest that the structural state of esophagus but not symptomatology dictates autonomic function status.
自主神经功能障碍在胃食管反流病（GERD）患者中经常被观察到，并且影响GERD的发病机制。然而，区分不同表现的GERD患者的特征仍不清楚。
研究GERD患者亚组的自主神经功能。
本研究的164名参与者中，57名是健康对照者，34名患有非糜烂性反流病（NERD），40名患有症状性食管炎（SE），33名患有无症状性食管炎（AE）。
通过测量5分钟心率变异性（HRV）和HRV指标来评估静息自主神经活动，这些指标包括时域参数（正常到正常间期的标准差[SDNN]和连续差值的均方根[RMSSD]）和频域参数（低频功率[LF；0.04 - 0.15赫兹]、高频功率[HF；0.15 - 0.4赫兹]以及LF/HF功率比）。使用自我报告问卷（简明症状评定量表[BSRS]）评估精神压力。
四组之间HF功率存在差异（方差分析，p = 0.041），但时域参数、LF功率、LF/HF功率比和BSRS参数无显著差异。NERD受试者的HF功率高于SE和AE受试者（LSD法：p均 = 0.02）。当分为两组（糜烂性与非糜烂性）时，几乎所有自主神经张力指标在糜烂性组均显著低于非糜烂性组。在回归分析中，年龄和内镜下食管炎的存在影响RMSSD和HF功率结果。精神压力或性别与任何HRV指标均无相关性。
与NERD受试者相比，内镜确诊的食管炎患者（即使无症状）的自主神经张力较低。这一发现可能表明食管的结构状态而非症状决定自主神经功能状态。
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