健康志愿者内毒素血症引起的心率变异性变化的昼夜节律。

Day-night variation in heart rate variability changes induced by endotoxaemia in healthy volunteers.

作者信息

Alamili M, Rosenberg J, Gögenur I

机构信息

Department of Surgery, Køge Hospital, Copenhagen University, Køge, Denmark.

出版信息

Acta Anaesthesiol Scand. 2015 Apr;59(4):457-64. doi: 10.1111/aas.12472. Epub 2015 Mar 1.

DOI:10.1111/aas.12472

PMID:25790066

Abstract

BACKGROUND

Morbidity and mortality in response to sepsis may be dependent on clock time for the initiation of sepsis. Endotoxaemia, an experimental model for systemic inflammation, induces alterations in sympatico-vagal balance in the autonomic nervous system (ANS). The activity of sympathetic and parasympathetic activity can be estimated by measuring heart rate variability (HRV). Based on the intimate link between ANS and the inflammatory response, we hypothesized, that HRV changes seen during endotoxaemia would be different based on time of the day the endotoxaemia is initiated. We investigated day/night variation in endotoxaemia-induced changes in HRV.

METHODS

A randomized, crossover study with 12 healthy men (age 18-31) was conducted. Endotoxaemia were induced by lipopolysaccharide (LPS) endotoxin 0.3 ng/kg b.w. in two visits (day visit and night visit). At the day visit, endotoxaemia were induced at 12:00 h, and at the night visit it was induced at 24:00 h. Holter recordings were started 1 h before administration of LPS, and continued for 10 h. Time-domain and frequency-domain parameters of HRV were analysed.

RESULTS

A total of nine persons finished the study with valid recordings. Endotoxaemia at both night and day resulted in a significant depression in HRV parameters high-frequency power (HF), low-frequency power (LF), standard deviation of normal-to-normal (NN) intervals, root mean square of successive differences and proportion of NN50 divided by total number of NNs (P<0.001). The ratio LF/HF and mean heart rate significantly increased by endotoxaemia (P<0.001). At night-time endotoxaemia, a more pronounced depression of LF, HF and SDNN (P<0.01) and a more pronounced increase in the ratio of LF/HF and mean heart rate (P<0.01) occurred compared with day-time endotoxaemia.

CONCLUSION

Endotoxaemia induced changes in HRV exhibit a day-night difference. This difference may have clinical consequences in patients with sepsis.

摘要

背景

脓毒症的发病率和死亡率可能取决于脓毒症起始的时钟时间。内毒素血症作为全身炎症的一种实验模型，可诱导自主神经系统（ANS）交感 - 迷走神经平衡发生改变。交感神经和副交感神经活动的活性可通过测量心率变异性（HRV）来估计。基于ANS与炎症反应之间的密切联系，我们推测，内毒素血症期间观察到的HRV变化会因内毒素血症起始的一天中的时间不同而有所差异。我们研究了内毒素血症诱导的HRV变化的昼夜差异。

方法

对12名健康男性（年龄18 - 31岁）进行了一项随机交叉研究。通过静脉注射0.3 ng/kg体重的脂多糖（LPS）内毒素诱导内毒素血症，分两次就诊（日间就诊和夜间就诊）进行。在日间就诊时，于12:00诱导内毒素血症，在夜间就诊时，于24:00诱导。在注射LPS前1小时开始进行动态心电图记录，并持续10小时。分析HRV的时域和频域参数。

结果

共有9人完成了具有有效记录的研究。白天和夜间的内毒素血症均导致HRV参数高频功率（HF）、低频功率（LF）、正常到正常（NN）间期的标准差、逐次差值的均方根以及NN50除以NN总数的比例显著降低（P<0.001）。内毒素血症使LF/HF比值和平均心率显著增加（P<0.001）。与白天内毒素血症相比，夜间内毒素血症时LF、HF和SDNN的降低更为明显（P<0.01），LF/HF比值和平均心率的增加也更为明显（P<0.01）。