Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Oct 3;79(Pt B):324-331. doi: 10.1016/j.pnpbp.2017.07.009. Epub 2017 Jul 12.
Inconsistent results have been reported with respect to cardiac autonomic function in major depression. The aim of our study was to investigate autonomic function in various branches of the autonomic nervous system in order to better understand parasympathetic and sympathetic modulation in the disease. We investigated 29 unmedicated patients suffering from major depression (MD) in comparison to matched control subjects (gender, age, BMI). The autonomic assessment at rest included values of heart rate variability (HRV), blood pressure variability (BPV), baroreflex sensitivity (BRS), respiration, skin conductance (SC) as well as the calculation of pupillary diameter and the unrest index (PUI). Results were compared by means of a multivariate analysis of variance. In a classification analysis, we identified suitable parameters for patient - control separation. Finally, to analyze interrelations of pupillometric parameters and autonomic indices, we estimated Pearson correlation coefficients and fitted a linear regression model. Apart from a significantly increased heart rate (75±12 vs. 65±6min, p<0.001) and decreased BRS (14±13 vs. 20±15ms/mmHg, p<0.05), we observed a lack of significant differences in HRV and BPV analysis between patients and controls. However, pupillary diameter (left: 4.3±0.9 vs. 3.8±0.6, p<0.01; right: 4.3±0.9 vs. 3.7±0.6mm, p<0.01) and PUI (left: 14.8±6.0 vs. 10.7±4.5mm/min, p<0.01; right: 14.1±5.5 vs. 10.7±4.8mm/min, p<0.01), as well as the level (left: 7.3±6.2 vs. 4.3±4.4 μS, p<0.05) and fluctuations of skin conductance (left: 4.2±4.1 vs. 2.5±3.6, p<0.05; right: 4.2±4.4 vs. 2.6±3.2, p<0.05) were significantly different. The classification accuracy was 88.5% with high specificity (e=92.9%) and sensitivity (s=83.3%) including heart rate, PUI and skin conductance. HRV indices correlated to PUI in controls but not in patients. Our data add evidence to the current debate on autonomic function in major depression. We suggest that diverse results are mainly caused by methodological shortcomings, in particular by the application of HRV assessment only, which misses changes of sympathetic modulation. The application of broader analyzing tools will clarify the pattern of autonomic function in depression and ultimately its role in cardiac morbidity and mortality.
在重度抑郁症中，心脏自主功能的结果不一致。我们的研究旨在调查自主神经系统各个分支的自主功能，以便更好地理解疾病中的副交感和交感调节。我们调查了 29 名未经治疗的患有重度抑郁症（MD）的患者与匹配的对照组（性别、年龄、BMI）进行比较。自主评估包括心率变异性（HRV）、血压变异性（BPV）、血压反射敏感性（BRS）、呼吸、皮肤电导（SC）以及瞳孔直径和非静止指数（PUI）的计算值。通过多元方差分析进行了比较。在分类分析中，我们确定了适合患者-对照分离的参数。最后，为了分析瞳孔测量参数和自主指数之间的相互关系，我们估计了 Pearson 相关系数并拟合了线性回归模型。除了心率显著增加（75±12 比 65±6min，p<0.001）和 BRS 降低（14±13 比 20±15ms/mmHg，p<0.05）外，我们还观察到患者和对照组之间 HRV 和 BPV 分析没有显著差异。然而，瞳孔直径（左：4.3±0.9 比 3.8±0.6，p<0.01；右：4.3±0.9 比 3.7±0.6mm，p<0.01）和 PUI（左：14.8±6.0 比 10.7±4.5mm/min，p<0.01；右：14.1±5.5 比 10.7±4.8mm/min，p<0.01）以及水平（左：7.3±6.2 比 4.3±4.4 μS，p<0.05）和皮肤电导的波动（左：4.2±4.1 比 2.5±3.6，p<0.05；右：4.2±4.4 比 2.6±3.2，p<0.05）差异显著。分类准确率为 88.5%，特异性（e=92.9%）和敏感性（s=83.3%）均较高，包括心率、PUI 和皮肤电导。在对照组中，HRV 指数与 PUI 相关，但在患者中不相关。我们的数据为当前关于重度抑郁症自主功能的争论提供了证据。我们认为，不同的结果主要是由于方法学上的缺陷造成的，特别是仅应用 HRV 评估会错过交感调节的变化。应用更广泛的分析工具将阐明抑郁症自主功能的模式，并最终阐明其在心脏发病率和死亡率中的作用。
