Straburzyńska-Migaj Ewa, Ochotny Romuald, Wachowiak-Baszyńska Anna, Straburzyńska-Lupa Anna, Leśniewska Kinga, Wiktorowicz Krzysztof, Cieśliński Andrzej
I Klinika Kardiologii, Katedra Kardiologii Akademii Medycznej, ul. Długa 1/2, 61-848 Poznań.
Kardiol Pol. 2005 Nov;63(5):478-85; discussion 486-7.
INTRODUCTION: Heart rate variability (HRV) analysis is a non-invasive method of assessment of the autonomic nervous system's effects on heart function. In chronic heart failure (CHF), decreased HRV correlates with the progression of the disease. It is also known that in CHF increased levels of proinflammatory cytokines are present. Because these molecules are believed to influence the nervous system at both the central and peripheral levels, their potential role in HRV reduction in the course of CHF has been proposed. AIM: The study was designed to verify potential relations between cytokines and HRV parameters in CHF patients. The concept of the study was driven by the recognition of controversies in this field and the paucity of published reports. METHODS: Forty-four patients with CHF and stable NYHA class I-IV symptoms and 15 healthy controls were enrolled in the study. Time-domain HRV analysis was performed based on of 24-hour Holter ECG monitoring. Plasma concentrations of soluble TNFalpha receptors sTNF-RI and sTNF-RII and interleukin 6 (IL-6) were measured using commercially available ELISA kits (Quantikine, RD Systems). RESULTS: In patients with CHF, HRV indices included in the analysis were significantly decreased, and the levels of cytokines increased in comparison with the control group. In the whole study population, both in the CHF patients and the control group, significant negative correlations were observed between sTNF-RI level and long-term HRV indices such as SDNN (r=-0.44; p=0.0006), SDANN (r=-0.44; p=0.0005) and short-time index SDNNI (r=-0.37; p=0.004). Similar negative correlations were found between sTNF-RII level and SDNN (r=-0.35; p=0.007), SDANN (r=-0.34; p=0.01), and SDNNI (r=-0.31; p=0.02), as well as between IL-6 level and SDNN (r=-0.41; p=0.001), SDANN (r=-0.44; p=0.0005) and SDNNI (r=-0.34; p=0.009). CONCLUSIONS: Significant negative correlations between TNF-alpha soluble receptors sTNF-RI, sTNF-RII and IL-6 levels and time-domain HRV parameters were observed in the study. Because the results of investigations conducted so far do not elucidate the cause-effect relationship, further studies are needed to clarify the mechanisms of HRV depression in CHF and the role of cytokines in this severe clinical condition.
引言：心率变异性（HRV）分析是一种评估自主神经系统对心脏功能影响的非侵入性方法。在慢性心力衰竭（CHF）中，HRV降低与疾病进展相关。还已知CHF患者体内促炎细胞因子水平升高。由于这些分子被认为会在中枢和外周水平影响神经系统，因此有人提出它们在CHF病程中HRV降低方面的潜在作用。 目的：本研究旨在验证CHF患者细胞因子与HRV参数之间的潜在关系。该研究的概念源于对该领域争议的认识以及已发表报告的匮乏。 方法：44例CHF患者，纽约心脏协会（NYHA）心功能分级为I - IV级且症状稳定，以及15名健康对照者纳入本研究。基于24小时动态心电图监测进行时域HRV分析。使用市售酶联免疫吸附测定试剂盒（Quantikine，RD Systems）测量血浆中可溶性肿瘤坏死因子α受体sTNF - RI和sTNF - RII以及白细胞介素6（IL - 6）的浓度。 结果：CHF患者中，分析所纳入的HRV指标显著降低，与对照组相比细胞因子水平升高。在整个研究人群中，包括CHF患者和对照组，均观察到sTNF - RI水平与长期HRV指标如标准差NN间期（SDNN，r = - 0.44；p = 0.0006）、平均NN间期的标准差（SDANN，r = - 0.44；p = 0.0005）以及短时指标标准化NN间期指数（SDNNI，r = - 0.37；p = 0.004）之间存在显著负相关。在sTNF - RII水平与SDNN（r = - 0.35；p = 0.007）、SDANN（r = - 0.34；p = 0.01）和SDNNI（r = - 0.31；p = 0.02）之间，以及IL - 6水平与SDNN（r = - 0.41；p = 0.001）、SDANN（r = - 0.44；p = 0.0005）和SDNNI（r = - 0.34；p = 0.009）之间也发现了类似的负相关。 结论：本研究观察到肿瘤坏死因子α可溶性受体sTNF - RI、sTNF - RII和IL - 6水平与时域HRV参数之间存在显著负相关。由于目前的研究结果尚未阐明因果关系，因此需要进一步研究以阐明CHF中HRV降低的机制以及细胞因子在这种严重临床状况中的作用。
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