1 Department of Internal Diseases and Clinical Pharmacology, 37808 Medical University of Lodz , Lodz, Poland.
2 Department of Dermatology and Venereology, 37808 Medical University of Lodz , Lodz, Poland.
Lupus. 2018 Mar;27(3):436-444. doi: 10.1177/0961203317725590. Epub 2017 Aug 10.
Background Systemic lupus erythematosus is a progressive autoimmune disease. There are reports suggesting that patients even without overt signs of cardiovascular complications have impaired autonomic function. The aim of this study was to assess autonomic function using heart rate turbulence and heart rate variability parameters indicated in 24-hour ECG Holter monitoring. Methods Twenty-six women with systemic lupus erythematosus and 30 healthy women were included. Twenty-four hour ambulatory ECG-Holter was performed in home conditions. The basic parameters of heart rate turbulence and heart rate variability were calculated. The analyses were performed for the entire day and separately for daytime activity and night time rest. Results There were no statistically significant differences in the basic anthropometric parameters. The mean duration of disease was 11.52 ± 7.42. There was a statistically significant higher turbulence onset (To) value in patients with systemic lupus erythematosus, median To = -0.17% (minimum -1.47, maximum 3.0) versus To = -1.36% (minimum -4.53, maximum -0.41), P < 0.001. There were no such differences for turbulence slope (Ts). In the 24-hour analysis almost all heart rate variability parameters were significantly lower in the systemic lupus erythematosus group than in the healthy controls, including SDANN and r-MSSD and p50NN. Concerning the morning activity and night resting periods, the results were similar as for the whole day. In the control group, higher values in morning activity were noted for parameters that characterise sympathetic activity, especially SDANN, and were significantly lower for parasympathetic parameters, including r-MSSD and p50NN, which prevailed at night. There were no statistically significant changes for systemic lupus erythematosus patients for p50NN and low and very low frequency. There was a positive correlation between disease duration and SDNN, R = 0.417; P < 0.05 and SDANN, R = 0.464; P < 0.05, a negative correlation between low/high frequency ratio and r-MSSD, R = -0.454; P < 0.05; p50NN, R = -0.435; P < 0.05 and high frequency, R = -0.478; P < 0.05. In contrast, there was no statistically significant correlation between heart rate turbulence and other variables evaluated, including disease duration and the type of autoantibodies.
Our study confirms the presence of autonomic disorders with respect to both heart rate variability and heart rate turbulence parameters and the presence of diurnal disturbances of sympathetic-parasympathetic balance. Further studies are required.
使用 24 小时心电图动态 Holter 监测中提示的心率震荡和心率变异性参数评估系统性红斑狼疮患者的自主神经功能。
共纳入 26 例系统性红斑狼疮女性患者和 30 例健康女性，在居家条件下进行 24 小时动态心电图监测。计算心率震荡和心率变异性的基本参数。分析在全天和白天活动及夜间休息时分别进行。
两组基本人体测量参数无统计学差异。平均疾病病程为 11.52±7.42 年。系统性红斑狼疮患者的心率震荡起始（To）值明显较高，中位数 To=-0.17%（最小值-1.47，最大值 3.0）vs To=-1.36%（最小值-4.53，最大值-0.41），P<0.001。而心率震荡斜率（Ts）无显著差异。在 24 小时分析中，系统性红斑狼疮组的几乎所有心率变异性参数均显著低于健康对照组，包括 SDANN 和 r-MSSD 和 p50NN。在上午活动和夜间休息期，结果与全天相似。在对照组中，上午活动时参数的交感神经活动较高，尤其是 SDANN，而副交感神经参数，包括 r-MSSD 和 p50NN，夜间明显较低。而系统性红斑狼疮患者的 p50NN 和低和极低频率无统计学差异。疾病病程与 SDNN 呈正相关，R=0.417；P<0.05 和 SDANN，R=0.464；P<0.05，低频/高频比值与 r-MSSD 呈负相关，R=-0.454；P<0.05；p50NN，R=-0.435；P<0.05 和高频，R=-0.478；P<0.05。相反，心率震荡与评估的其他变量，包括疾病病程和自身抗体类型之间无统计学相关性。
本研究证实，系统性红斑狼疮患者自主神经功能障碍与心率变异性和心率震荡参数有关，并且存在交感神经-副交感神经平衡的昼夜节律紊乱。需要进一步研究。
