Huang Wei-Lieh, Liao Shih-Cheng, Yang Cheryl C H, Kuo Terry B J, Chen Tzu-Ting, Chen I-Ming, Gau Susan Shur-Fen
From the Department of Psychiatry (Huang, Chen), National Taiwan University Hospital, Yun-Lin Branch, Yunlin; Department of Psychiatry (Huang, Liao, Chen, Gau), National Taiwan University Hospital; Department of Psychiatry (Huang, Liao, Gau), Graduate Institute of Clinical Medicine (Huang, Gau), College of Medicine, National Taiwan University; Institute of Brain Science (Yang, Kuo), National Yang-Ming University; and Institute of Health Policy and Management (Chen), College of Public Health, National Taiwan University, Taipei, Taiwan.
Psychosom Med. 2017 Jan;79(1):34-42. doi: 10.1097/PSY.0000000000000362.
Little is known about autonomic nervous system activity in individuals with somatic symptom disorder (SSD) as defined by DSM-V criteria. The aims of this study were to investigate whether individuals with SSD differ from healthy controls in heart rate variability (HRV) measures of autonomic nervous system activity and whether sex has a moderating effect on this association.
We recruited 168 individuals with SSD (35.1% men) and 106 healthy controls (27.4% men). Demographics, HRV, and psychological factors were measured using the Patient Health Questionnaire-15, Health Anxiety Questionnaire, Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory. Multiple regression analysis was used to examine the association of SSD with HRV, adjusting for demographic and psychological measures.
Individuals with SSD had lower levels of total-power HRV and low-frequency HRV, but no differences in high-frequency (HF)-HRV were found. HRV differences between SSD and controls varied by sex and age (triple interaction TP-HRV β = -0.222, p < .001; low-frequency HRV β = -0.332, p < .001; and HF-HRV β = -0.167, p = .006). Whole-sample multiple regression analyses revealed significant sex differences in the magnitudes of the association between BDI-II with HF-HRV (β of sex*BDI-II: 0.761, p = .005) and analyses stratified by sex indicated that HF-HRV was significantly correlated with depression in men with SSD (r = -0.491, p < .001) but not in women with SSD (r = 0.057, p = .558).
These results suggest that patients with SSD demonstrate different patterns of HRV and the patterns of association between HRV indices and psychological factors vary between men and women.
对于符合《精神疾病诊断与统计手册》第五版（DSM-V）标准的躯体症状障碍（SSD）患者的自主神经系统活动，我们了解甚少。本研究旨在调查SSD患者在自主神经系统活动的心率变异性（HRV）测量方面是否与健康对照者存在差异，以及性别是否对这种关联具有调节作用。
我们招募了168名SSD患者（男性占35.1%）和106名健康对照者（男性占27.4%）。使用患者健康问卷-15、健康焦虑问卷、贝克抑郁量表第二版（BDI-II）和贝克焦虑量表对人口统计学、HRV和心理因素进行测量。采用多元回归分析来检验SSD与HRV之间的关联，并对人口统计学和心理测量指标进行校正。
SSD患者的总功率HRV和低频HRV水平较低，但高频（HF）-HRV未发现差异。SSD患者与对照者之间的HRV差异因性别和年龄而异（三元交互作用总功率HRVβ=-0.222，p<.001；低频HRVβ=-0.332，p<.001；高频HRVβ=-0.167，p=.006）。全样本多元回归分析显示，BDI-II与高频HRV之间关联的强度存在显著性别差异（性别*BDI-II的β：0.761，p=.005），按性别分层的分析表明，高频HRV与男性SSD患者的抑郁显著相关（r=-0.491，p<.001），而与女性SSD患者无关（r=0.057，p=.558）。
这些结果表明SSD患者表现出不同的HRV模式，且HRV指标与心理因素之间的关联模式在男性和女性之间有所不同。
