Adlan Ahmed M, Veldhuijzen van Zanten Jet J C S, Lip Gregory Y H, Paton Julian F R, Kitas George D, Fisher James P
College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
University of Birmingham Centre of Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
Auton Neurosci. 2017 Dec;208:137-145. doi: 10.1016/j.autneu.2017.09.003. Epub 2017 Sep 13.
Rheumatoid arthritis (RA) is a chronic inflammatory condition characterised by reduced heart rate variability (HRV) of unknown cause. We tested the hypothesis that low HRV, indicative of cardiac autonomic cardiovascular dysfunction, was associated with systemic inflammation and pain. Given the high prevalence of hypertension (HTN) in RA, a condition itself associated with low HRV, we also assessed whether the presence of hypertension further reduced HRV in RA.
In RA-normotensive (n=13), RA-HTN (n=17), normotensive controls (NC; n=17) and HTN (n=16) controls, blood pressure and heart rate were recorded. Time and frequency domain measures of HRV along with serological markers of inflammation (high sensitivity C-reactive protein [hs-CRP], tumour necrosis factor-α [TNF-α] and interleukins [IL]) were determined. Reported pain was assessed using a visual analogue scale.
Time (rMSSD, pNN50%) and frequency (high frequency power, low frequency power, total power) domain measures of HRV were lower in the RA, RA-HTN and HTN groups, compared to NC (p=0.001). However, no significant differences in HRV were noted between the RA, RA-HTN and HTN groups. Inverse associations were found between time and frequency measures of HRV and inflammatory cytokines (IL-6 and IL-10), but were not independent after multivariable analysis. hs-CRP and pain were independently and inversely associated with time domain (rMMSD, pNN50%) parameters of HRV.
These findings suggest that lower HRV is associated with increased inflammation and independently associated with increased reported pain, but not compounded by the presence of HTN in patients with RA.
类风湿关节炎（RA）是一种慢性炎症性疾病，其特征为心率变异性（HRV）降低，病因不明。我们检验了以下假设：低HRV（提示心脏自主神经心血管功能障碍）与全身炎症和疼痛相关。鉴于RA患者中高血压（HTN）的高患病率，而高血压本身与低HRV相关，我们还评估了高血压的存在是否会进一步降低RA患者的HRV。
对RA血压正常组（n = 13）、RA合并HTN组（n = 17）、血压正常对照组（NC；n = 17）和HTN对照组（n = 16）进行血压和心率记录。测定HRV的时域和频域指标以及炎症血清学标志物（高敏C反应蛋白[hs-CRP]、肿瘤坏死因子-α[TNF-α]和白细胞介素[IL]）。使用视觉模拟量表评估报告的疼痛情况。
与NC组相比，RA组、RA合并HTN组和HTN组的HRV时域指标（rMSSD、pNN50%）和频域指标（高频功率、低频功率、总功率）均较低（p = 0.001）。然而，RA组、RA合并HTN组和HTN组之间的HRV无显著差异。HRV的时域和频域指标与炎症细胞因子（IL-6和IL-10）呈负相关，但多变量分析后并非独立相关。hs-CRP和疼痛与HRV的时域参数（rMMSD、pNN50%）独立且呈负相关。
这些发现表明，较低的HRV与炎症增加相关，且与报告的疼痛增加独立相关，但在RA患者中不会因HTN的存在而加重。
