Xu Yan-Hong, Wang Xing-De, Yang Jia-Jun, Zhou Li, Pan Yong-Chao
Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
Clin Interv Aging. 2016 Mar 11;11:293-8. doi: 10.2147/CIA.S99542. eCollection 2016.
Autonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC) and deceleration capacity (DC) of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke.
A 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN), and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD) were calculated. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores.
The R-R (R wave to R wave on electrocardiogram) intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043), but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC|) and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004). Correlation analysis also showed that DC, |AC|, and SDNN were negatively correlated with NIHSS scores (r=-0.279, r=-0.266, and r=-0.319; P=0.027, P=0.035, and P=0.011).
Both DC and AC of heart rate decreased in patients with hemispheric infarction, reflecting a decrease in both vagal and sympathetic modulation. Both DC and AC were correlated with the severity of stroke.
自主神经功能障碍在卒中后很常见，且与不良预后相关。相位整流信号平均技术是一种新开发的用于评估心脏自主神经功能的技术，通过计算心率的加速能力（AC）和减速能力（DC）分别检测交感神经和迷走神经活动。在本研究中，我们首次使用该技术来研究急性半球缺血性卒中患者的心脏自主神经功能。
对63例首次发生半球急性缺血性卒中且为窦性心律的患者以及50例卒中高危对照者进行24小时动态心电图监测。计算DC、AC、心率变异性参数、全部正常RR间期的标准差（SDNN）以及相邻RR间期差值平方和均值的平方根（RMSSD）。采用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度。我们分析了DC、AC、SDNN和RMSSD的变化，并研究了这些参数与NIHSS评分之间的相关性。
脑梗死组的RR间期、DC、AC和SDNN低于对照组（P = 0.003、P = 0.002、P = 0.006和P = 0.043），但RMSSD以及AC绝对值（|AC|）与DC的差值和比值与对照组相比差异无统计学意义。梗死组的DC与|AC|、SDNN和RMSSD显著相关（r = 0.857、r = 0.619和r = 0.358；P = 0.000、P = 0.000和P = 0.004）。相关性分析还显示，DC、|AC|和SDNN与NIHSS评分呈负相关（r = -0.279、r = -0.266和r = -0.319；P = 0.027、P = 0.035和P = 0.011）。
半球梗死患者的心率DC和AC均降低，反映迷走神经和交感神经调节均减弱。DC和AC均与卒中严重程度相关。
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