Kojima Masayo, Hayano Junichiro, Fukuta Hidekatsu, Sakata Seiichiro, Mukai Seiji, Ohte Nobuyuki, Seno Hachiro, Toriyama Takanobu, Kawahara Hirohisa, Furukawa Toshiaki A, Tokudome Shinkan
Department of Health Promotion and Preventive Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Psychosom Med. 2008 Feb;70(2):177-85. doi: 10.1097/PSY.0b013e31816477a1. Epub 2008 Feb 6.
To assess the relationship between depression, reduced heart rate (HR) variability, and altered HR dynamics among patients with end-stage renal disease who are receiving hemodialysis (HD) therapy.
We analyzed the 24-hour electrocardiograms of 119 outpatients receiving chronic HD. HR variability was quantified with the standard deviation of normal-to-normal R-R intervals, the triangular index, and the powers of the high- (HF), low- (LF), very-low (VLF), and ultra-low frequency (ULF) components. Nonlinear HR dynamics was assessed with the short-term (alpha(1)) and long-term (alpha(2)) scaling exponents of the detrended fluctuation analysis and approximate entropy. The depression level was assessed using the Beck Depression Inventory, Second Edition (BDI-II). HR variability and dynamics measurements were compared by gender, diabetes, and depression with adjustment for age and serum albumin concentration.
Most indices of HR variability and dynamics were negatively correlated with age, serum albumin concentration, depression score, and were lower in women and patients with diabetes. The alpha(2) was inversely associated with these variables. Depressed men had significantly lower HF, LF, VLF, and marginally lower ULF than nondepressed persons after adjustment for diabetes and other covariates; no difference in depression was observed in women. The alpha(2) showed marginally significant difference in depression independent from gender and diabetes.
Among the patients who received HD, depression is associated with reduced HR variability and loss of fractal HR dynamics. However, the influence of depression on HR variability may vary by gender and physiological backgrounds. Further prospective studies are necessary to confirm their association with poor prognosis.
评估接受血液透析（HD）治疗的终末期肾病患者中抑郁、心率（HR）变异性降低与HR动力学改变之间的关系。
我们分析了119例接受慢性HD治疗的门诊患者的24小时心电图。HR变异性通过正常RR间期的标准差、三角指数以及高频（HF）、低频（LF）、极低频（VLF）和超低频（ULF）成分的功率进行量化。非线性HR动力学通过去趋势波动分析的短期（α(1)）和长期（α(2)）标度指数以及近似熵进行评估。使用贝克抑郁量表第二版（BDI-II）评估抑郁水平。对HR变异性和动力学测量结果按性别、糖尿病和抑郁情况进行比较，并对年龄和血清白蛋白浓度进行校正。
HR变异性和动力学的大多数指标与年龄、血清白蛋白浓度、抑郁评分呈负相关，在女性和糖尿病患者中较低。α(2)与这些变量呈负相关。在对糖尿病和其他协变量进行校正后，抑郁男性的HF、LF、VLF显著低于非抑郁者，ULF略低；女性在抑郁方面未观察到差异。α(2)在抑郁方面显示出与性别和糖尿病无关的边缘显著差异。
在接受HD治疗的患者中，抑郁与HR变异性降低和分形HR动力学丧失有关。然而，抑郁对HR变异性的影响可能因性别和生理背景而异。需要进一步的前瞻性研究来证实它们与不良预后的关联。
