Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
J Basic Clin Physiol Pharmacol. 2021 Mar 12;32(3):247-253. doi: 10.1515/jbcpp-2020-0378.
The novel corona virus disease, which was initially reported in China in late 2019, has become a global pandemic affecting 330 million cases. COVID-19 affects predominantly the respiratory system, in addition to other organ systems, mainly the cardiovascular system. One of the hypotheses is that virus entering the target cells by binding to angiotensin converting enzyme 2 affecting hypothalamic pituitary axis could lead to dysautonomia which is measured by heart rate variability (HRV). HRV is a non-invasive measure of autonomic function that facilitates identification of COVID-19 patients at the risk of developing cardiovascular complications. So, we aimed to assess HRV in COVID patients and compare between COVID patients and normal controls.
In a case control design, we compared 63 COVID-19 infected patients with 43 healthy controls matched for age and gender. Along with clinical characterization, heart rate variability was evaluated using ambulatory 5 min ECG in lead II and expressed in frequency and time domain measures. Statistical analysis was performed using SPSS 17.0.
Mean age of the study population was 49.1 ± 14.2 years and 71 (66.9%) were males. Frequency domain measures high (HF) and low (LF) frequency powers were significantly decreased in COVID-19 patients compared to controls. HF/LF and LF/HF ratios were not different between groups. Time domain measures rMSSD (root mean square of successive RR interval differences) and SDNN (standard deviation of NN intervals) were significantly increased among COVID-19 subjects. COVID-19 infection was associated with increased parasympathetic activity as defined by rMSSD>40 {adjusted odds ratio 7.609 (95% CI 1.61-35.94); p=0.01} and SDNN>60 {adjusted odds ratio 2.620 (95% CI 1.070-6.44); p=0.035} after adjusting for age, gender and comorbidities.
Our study results showed increased parasympathetic tone in COVID patients. Early diagnosis of autonomic imbalance in COVID patients is needed to plan management and limit progression of disease.
最初于 2019 年底在中国报告的新型冠状病毒病已成为影响 3.3 亿例的全球大流行。COVID-19 主要影响呼吸系统，除其他器官系统外，主要影响心血管系统。其中一种假设是，病毒通过与血管紧张素转换酶 2 结合进入靶细胞，从而影响下丘脑-垂体轴，导致自主神经功能障碍，这可以通过心率变异性（HRV）来衡量。HRV 是自主功能的一种非侵入性测量方法，有助于识别有发生心血管并发症风险的 COVID-19 患者。因此，我们旨在评估 COVID 患者的 HRV，并比较 COVID 患者与正常对照者之间的差异。
采用病例对照设计，我们比较了 63 例 COVID-19 感染患者和 43 例年龄和性别匹配的健康对照者。除了临床特征外，我们还通过 II 导联的动态 5 分钟心电图评估心率变异性，并以频域和时域测量表示。统计分析使用 SPSS 17.0 进行。
研究人群的平均年龄为 49.1±14.2 岁，其中 71 人（66.9%）为男性。与对照组相比，COVID-19 患者的频域测量高频（HF）和低频（LF）功率明显降低。HF/LF 和 LF/HF 比值在两组之间无差异。时域测量 rMSSD（连续 RR 间期差异的均方根）和 SDNN（NN 间期标准差）在 COVID-19 患者中明显增加。COVID-19 感染与迷走神经活动增加相关，rMSSD>40{调整后的优势比 7.609（95%CI 1.61-35.94）；p=0.01}和 SDNN>60{调整后的优势比 2.620（95%CI 1.070-6.44）；p=0.035}，校正年龄、性别和合并症后。
我们的研究结果表明 COVID 患者迷走神经张力增加。需要早期诊断 COVID 患者的自主神经失衡，以便计划管理并限制疾病的进展。
