Ferrario Manuela, Moissl Ulrich, Garzotto Francesco, Cruz Dinna N, Tetta Ciro, Signorini Maria G, Ronco Claudio, Grassmann Aileen, Cerutti Sergio, Guzzetti Stefano
Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Italy.
Fresenius Medical Care R&D, Bad Homburg, Germany.
PLoS One. 2015 Mar 20;10(3):e0120167. doi: 10.1371/journal.pone.0120167. eCollection 2015.
The hypothesis that central volume plays a key role in the source of low frequency (LF) oscillations of heart rate variability (HRV) was tested in a population of end stage renal disease patients undergoing conventional hemodialysis (HD) treatment, and thus subject to large fluid shifts and sympathetic activation. Fluid overload (FO) in 58 chronic HD patients was assessed by whole body bioimpedance measurements before the midweek HD session. Heart Rate Variability (HRV) was measured using 24-hour Holter electrocardiogram recordings starting before the same HD treatment. Time domain and frequency domain analyses were performed on HRV signals. Patients were retrospectively classified in three groups according to tertiles of FO normalized to the extracellular water (FO/ECW%). These groups were also compared after stratification by diabetes mellitus. Patients with the low to medium hydration status before the treatment (i.e. 1st and 2nd FO/ECW% tertiles) showed a significant increase in LF power during last 30 min of HD compared to dialysis begin, while no significant change in LF power was seen in the third group (i.e. those with high pre-treatment hydration values). In conclusion, several mechanisms can generate LF oscillations in the cardiovascular system, including baroreflex feedback loops and central oscillators. However, the current results emphasize the role played by the central volume in determining the power of LF oscillations.
在接受常规血液透析（HD）治疗、因而会出现大量液体转移和交感神经激活的终末期肾病患者群体中，对中心血容量在心率变异性（HRV）低频（LF）振荡源中起关键作用这一假说进行了验证。通过在周中HD治疗前进行全身生物电阻抗测量，评估了58例慢性HD患者的液体超负荷（FO）情况。使用在同一次HD治疗前开始的24小时动态心电图记录来测量心率变异性（HRV）。对HRV信号进行了时域和频域分析。根据校正至细胞外液的FO三分位数（FO/ECW%），将患者回顾性分为三组。在按糖尿病分层后，也对这些组进行了比较。与透析开始时相比，治疗前处于低至中等水合状态的患者（即第1和第2 FO/ECW%三分位数）在HD治疗的最后30分钟内LF功率显著增加，而第三组（即治疗前水合值高的患者）的LF功率未见显著变化。总之，多种机制可在心血管系统中产生LF振荡，包括压力反射反馈回路和中枢振荡器。然而，目前的结果强调了中心血容量在决定LF振荡功率方面所起的作用。
