Department of Physiology, University College of Medical sciences and GTB Hospital, Delhi, India.
Department of Psychiatry, University College of Medical Sciences and GTB Hospital, Delhi, India.
Int J Psychiatry Clin Pract. 2020 Jun;24(2):135-142. doi: 10.1080/13651501.2020.1723642. Epub 2020 Feb 5.
The study examined the effect on cardiac autonomic tone via heart rate variability (HRV), brain derived neurotrophic factor (BDNF) in newly diagnosed generalised anxiety disorder (GAD) cases with paroxetine-controlled release (PX) CR intervention. Fifty GAD cases using DSM-5 criteria, matched with healthy controls (HC) were assessed with clinical measures (Hamilton Anxiety Scale (HAM-A), Clinical Global Impression- Severity Scale (CGI-Severity), General Health Questionnaire -12 (GHQ-12), HRV, plasma BDNF levels initially and 6 weeks postintervention with paroxetine CR. HRV parameters were significantly lower in GAD vs HC at baseline for standard deviation of normal to normal intervals (SDNN) and proportion of differences in consecutive NN intervals that are longer than 50 ms (pNN50). Significantly higher plasma BDNF levels were noted between HC versus GAD at baseline. Postintervention HAM-A, CGI scores, GHQ-12 item scores showed significant reduction. Significant differences also noted in square root of mean squared difference of successive NN intervals (RMSSD), (SDNN), pNN50 and in plasma BDNF levels after intervention within GAD group. Significant negative correlation observed between HAM-A scores and SDNN parameter after taking PX CR in GAD. GAD showed cardiac autonomic dysfunction, lowered plasma BDNF levels and their improvement with paroxetine CR.Key messageGAD is associated with significantly lower HRV, suggestive of cardiac autonomic dysfunction and lowered plasma BDNF levels, an indicator of stress.Therapeutic intervention with Paroxetine in GAD patients showed clinically significant improvement reflecting restoration of the cardiac autonomic tone and BDNF levels, thus implying their role as potential biomarkers.
该研究通过心率变异性（HRV）和脑源性神经营养因子（BDNF）检测，评估帕罗西汀控释片（PX CR）干预对新诊断的广泛性焦虑障碍（GAD）患者心脏自主神经张力的影响。采用 DSM-5 标准诊断为 GAD 的 50 例患者与健康对照者（HC）相匹配，在基线和干预 6 周后，分别使用临床量表（汉密尔顿焦虑量表（HAM-A）、临床总体印象-严重程度量表（CGI-Severity）、一般健康问卷-12 项（GHQ-12）、HRV、BDNF 水平进行评估。与 HC 相比，GAD 患者在基线时 HRV 参数的标准差（SDNN）和连续 NN 间期差值大于 50ms 的比例（pNN50）明显较低。与 GAD 相比，HC 患者在基线时的 BDNF 水平明显较高。干预后，HAM-A、CGI 评分和 GHQ-12 项目评分显著降低。GAD 组干预后，平方均方根差的连续 NN 间期（RMSSD）、SDNN、pNN50 和 BDNF 水平也有显著差异。在 GAD 中，干预后 HAM-A 评分与 SDNN 呈显著负相关。GAD 患者存在心脏自主神经功能障碍，血浆 BDNF 水平降低，而 PX CR 治疗后可改善这些情况。结论：GAD 与 HRV 明显降低有关，提示存在心脏自主神经功能障碍和 BDNF 水平降低，这是压力的一个指标。帕罗西汀治疗 GAD 患者可显著改善，反映出心脏自主神经张力和 BDNF 水平的恢复，提示它们可能作为潜在的生物标志物。
