Ates Fehmi, Topal Ergun, Kosar Feridun, Karincaoglu Melih, Yildirim Bulent, Aksoy Yuksel, Aladag Murat, Harputluoglu Murat M M, Demirel Ulvi, Alan Hakan, Hilmioglu Fatih
Department of Gastroenterology, Inonu University, Turgat Ozal Tip Merkezi, Malatya 44000, Turkey.
Dig Dis Sci. 2006 Sep;51(9):1614-8. doi: 10.1007/s10620-006-9073-9. Epub 2006 Aug 22.
Many studies have demonstrated that cirrhosis is frequently associated with autonomic dysfunction. The aim of this study was to test autonomic dysfunction in cirrhotic patients by analyzing heart rate variability (HRV), to determine whether or not the degree of autonomic dysfunction is correlated with the severity of disease, and, also, to compare the changes of HRV between survivor and nonsurvivor groups after 2-year follow-up periods. HRV was analyzed using 24-hr ECG recording in 30 cirrhotic patients and 28 normal controls. The changes in HRV parameters including mean normal-to-normal (N-N) interbeat intervals (mean NN), standard deviation of all N-N intervals (SDNN), standard deviation of the average of N-N intervals for each 5-min period over 24 hr (SDANN), root mean square succesive differences (r-MSSD; msec), and percentage of adjacent N-N intervals that are >50 msec apart (pNN50), all as time domain parameters, were evaluated. The cirrhotic patients were also evaluated according to Child-Pugh classification scores as markers of the disease severity. The time-domain measures of HRV in cirrhotic patients were significantly reduced compared with those in the control group (for all parameters; P < 0.001). The severity of disease was associated with reduced HRV measures (for all parameters; P < 0.001). After the 2-year follow-up periods, HRV measurements in cirrhotic patients were significantly much lower in nonsurvivors than in survivors (P < 0.001 for all). We conclude that increasing severity of cirrhosis is associated with a reduction in HRV. This finding may be an indicator of poor prognosis and mortality for cirrhosis.
许多研究表明，肝硬化常与自主神经功能障碍相关。本研究的目的是通过分析心率变异性（HRV）来检测肝硬化患者的自主神经功能障碍，确定自主神经功能障碍的程度是否与疾病严重程度相关，并且还要比较2年随访期后存活组和非存活组之间HRV的变化。使用24小时心电图记录对30例肝硬化患者和28名正常对照者进行HRV分析。评估HRV参数的变化，包括平均正常到正常（N-N）心跳间期（平均NN）、所有N-N间期的标准差（SDNN）、24小时内每5分钟时间段N-N间期平均值的标准差（SDANN）、均方根连续差值（r-MSSD；毫秒）以及相邻N-N间期相差>50毫秒的百分比（pNN50），所有这些均作为时域参数。还根据Child-Pugh分类评分对肝硬化患者进行评估，作为疾病严重程度的指标。与对照组相比，肝硬化患者HRV的时域测量值显著降低（所有参数；P<0.001）。疾病严重程度与HRV测量值降低相关（所有参数；P<0.001）。经过2年随访期后，肝硬化患者中，非存活者的HRV测量值显著低于存活者（所有参数P<0.001）。我们得出结论，肝硬化严重程度增加与HRV降低相关。这一发现可能是肝硬化预后不良和死亡率高的一个指标。
