Jang Aelee, Hwang Sun-Kyung, Padhye Nikhil S, Meininger Janet C
School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA.
College of Nursing, Pusan National University, Yangsan, Gyeongsangnam-do, Korea.
J Neurogastroenterol Motil. 2017 Jul 30;23(3):435-445. doi: 10.5056/jnm17017.
BACKGROUND/AIMS: The relation between heart rate variability (HRV) as non-invasive biomarkers of autonomic function and cognitive behavior therapy (CBT) as non-pharmacological treatments has rarely been examined in patients with constipation-predominant irritable bowel syndrome (IBS-C). The purpose of this study is to evaluate the efficacy of an 8-week CBT intervention on HRV and IBS symptoms, and the correlation of changes in HRV with changes in IBS symptoms among young female nursing students with IBS-C.
This study consisted of an exploratory subgroup analysis of 43 participants with IBS-C who had been randomly assigned to receive either 8 weeks of CBT (n = 23) or general medical information (control, n = 20). At baseline and 8, 16, and 24 weeks, participants completed a questionnaire assessing their gastrointestinal (GI) symptoms, anxiety, depression, and stress, and their HRV was measured via electrocardiography.
At the 8-week follow-up, the high-frequency (HF) power was significantly higher, and the low-frequency (LF)/HF ratio was lower in the CBT group than in the control group ( < 0.001 for both), and the severity of GI symptoms ( = 0.003), anxiety ( < 0.001), depression ( < 0.001), and stress ( < 0.001) was significantly lower in the CBT group than in the control group. Changes in the HF power were significantly and inversely associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks ( < 0.05 for all; range of from -0.37 to -0.68). Changes in the LF/HF ratio were also significantly and positively associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks ( < 0.05 for all; range of from 0.38 to 0.60).
CBT was effective in managing symptoms in young IBS-C patients and the improvement of symptoms was sustained at 24 weeks following the completion of CBT. Furthermore, indirect measurement of autonomic function using HRV may be a useful objective parameter for assessing response to CBT in young IBS-C patients.
背景/目的：作为自主神经功能无创生物标志物的心率变异性（HRV）与作为非药物治疗方法的认知行为疗法（CBT）之间的关系，在以便秘为主的肠易激综合征（IBS-C）患者中鲜有研究。本研究旨在评估为期8周的CBT干预对HRV和IBS症状的疗效，以及在患有IBS-C的年轻女护生中HRV变化与IBS症状变化之间的相关性。
本研究包括对43名IBS-C参与者的探索性亚组分析，这些参与者被随机分配接受为期8周的CBT（n = 23）或一般医学信息（对照组，n = 20）。在基线以及第8、16和24周时，参与者完成一份问卷，评估其胃肠道（GI）症状、焦虑、抑郁和压力，并通过心电图测量其HRV。
在8周随访时，CBT组的高频（HF）功率显著更高，低频（LF）/HF比值更低（两者均P<0.001），并且CBT组的GI症状严重程度（P = 0.003）、焦虑（P<0.001）、抑郁（P<0.001）和压力（P<0.001）均显著低于对照组。在第16周和24周时，HF功率变化与GI症状、焦虑、抑郁和压力变化显著负相关（均P<0.05；r范围为-0.37至-0.68）。LF/HF比值变化在第16周和24周时也与GI症状、焦虑、抑郁和压力变化显著正相关（均P<0.05；r范围为0.38至0.60）。
CBT对年轻IBS-C患者的症状管理有效，且在CBT完成后的24周内症状改善持续存在。此外，使用HRV间接测量自主神经功能可能是评估年轻IBS-C患者对CBT反应的有用客观参数。
