Doğru Mehmet Tolga, Aydin Gülümser, Tosun Aliye, Keleş Işik, Güneri Mahmut, Arslan Ayşe, Ebinç Haksun, Orkun Sevim
Department of Cardiology, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey.
Anadolu Kardiyol Derg. 2009 Apr;9(2):110-7.
It is known that increased sympathetic activity and decreased parasympathetic activity are present in patients with fibromyalgia syndrome (FMS). This study aims to investigate the correlations of autonomic dysfunction and differences in autonomic circadian activity with arrhythmia prevalence in women with FMS.
Fifty female patients with FMS and 30 healthy female controls were included in this cross-sectional, case-controlled study. A 12-lead electrocardiogram and 24-hour Holter monitoring were performed in all patients to evaluate arrhythmias and autonomic function tests. Heart rate variability (HRV) parameters were utilized to detect autonomic dysfunction in patients with FMS. HRV measurements were performed in total 24-hour, day time (06:00-22:59), night time (23:00-05:59) periods and during autonomic tests (stand - supine, inspiration-expiration and Valsalva tests) using 24-hour Holter monitoring recordings. Student t-test , Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The correlation of data was tested by using Spearman correlation analysis.
The mean ages of the patient and control groups were 38+/- 7.4 and 36+/- 8.1 years, respectively. In HRV measurements, high frequency (HF) power, was significantly decreased in the patient group as compared with control group (167.4 msec2 (107.0- 312.0) vs.314.5 msec2 (124.0- 905.0), p=0.017). The low frequency/HF ratio (LF/HF) values for total 24 hours (2.22+/- 0.18 vs. 1.22+/- 0.12, <0.001) and in the night time period (2.78+/- 1.97 vs.1.15+/- 0.77, <0.001) were found to be significantly higher in the patient group than in control one. The ratio of LF/HFDay / LF/HFNight was markedly higher in the control group (2.67 (1.22- 5.65) vs. 1.45 (0.83- 2.05), p=0.004). The prevalence (p=0.028) and total number (127.1+/- 21.4 vs. 187.3+/- 62.3, p=0.019) of supraventricular extrasystoles in 24-hour period was higher in the patient group.
The sympathetic activity was significantly increased and parasympathetic activity significantly decreased in FMS patients. Additionally, significant autonomic circadian activity changes were also detected in these patients. These autonomic changes might be linked to increased arrhythmia prevalence.
已知纤维肌痛综合征（FMS）患者存在交感神经活动增强和副交感神经活动减弱的情况。本研究旨在探讨FMS女性患者自主神经功能障碍及其昼夜节律活动差异与心律失常患病率之间的相关性。
本横断面病例对照研究纳入了50例FMS女性患者和30例健康女性对照。所有患者均进行了12导联心电图和24小时动态心电图监测，以评估心律失常和自主神经功能测试。采用心率变异性（HRV）参数检测FMS患者的自主神经功能障碍。使用24小时动态心电图监测记录，在24小时、白天（06:00 - 22:59）、夜间（23:00 - 05:59）以及自主神经测试（站立 - 仰卧、吸气 - 呼气和瓦尔萨尔瓦试验）期间进行HRV测量。采用学生t检验、曼 - 惠特尼U检验和皮尔逊卡方检验对组间数据进行比较。通过斯皮尔曼相关分析检验数据的相关性。
患者组和对照组的平均年龄分别为38±7.4岁和36±8.1岁。在HRV测量中，与对照组相比，患者组的高频（HF）功率显著降低（167.4毫秒²（107.0 - 312.0）vs. 314.5毫秒²（124.0 - 905.0），p = 0.017）。患者组24小时总时长（2.22±0.18 vs. 1.22±0.12，<0.001）和夜间时段（2.78±1.97 vs. 1.15±0.77，<0.001）的低频/高频比值（LF/HF）显著高于对照组。对照组的LF/HF日/LF/HF夜比值明显更高（2.67（1.22 - 5.65）vs. 1.45（0.83 - 2.05），p = 0.004）。患者组24小时内室上性早搏的患病率（p = 0.028）和总数（127.1±21.4 vs. 187.3±62.3，p = 0.019）更高。
FMS患者的交感神经活动显著增强，副交感神经活动显著减弱。此外，还检测到这些患者存在明显的自主神经昼夜节律活动变化。这些自主神经变化可能与心律失常患病率增加有关。
