Ferdous Suraiya, Rajasegaran Rajalakshmi, Munisamy Malathi, Basu Sharbari, Harichandrakumar K T
From the Department of Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Sawangi (Meghe), Wardha, Maharashtra, India.
Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research Institute (JIPMER), Puducherry, India.
Indian J Dermatol. 2023 May-Jun;68(3):261-267. doi: 10.4103/ijd.ijd_648_22.
Chronic stress, a potential risk factor for cardiac autonomic dysfunction and cardiovascular (CV) risk, is known to induce the onset and exacerbation of chronic spontaneous urticaria (CSU), a psychodermatological disorder. However, data regarding CV risks due to the stress associated with CSU are very limited.
This study aimed at comparing the cardiac sympathovagal balance (SVB), inflammatory markers, perceived stress and quality of sleep in patients with CSU (test group) and normal subjects (control group). In addition, it also aimed at assessing the correlation between the SVB and other study parameters in individuals with CSU.
Thirty-four patients with CSU and twenty-eight age- and gender-matched healthy controls were recruited for the study. Heart rate variability (HRV), baroreflex sensitivity (BRS) and biochemical markers of stress and inflammation (s-cortisol, interleukin (IL)-6, IL-18 and high sensitivity C-reactive protein (hs-CRP)) were assessed following standard procedures. Perceived stress and sleep quality were assessed using pre-validated questionnaires. Study parameters were compared between the test and control groups using the independent-samples Student's -test or Mann-Whitney U-test. The correlation between SVB and other study parameters was assessed using Spearman's rank correlation coefficient test. < 0.05 was considered statistically significant.
Levels of perceived stress, inflammatory markers, mean arterial pressure (MAP), myocardial workload (rate pressure product (RPP)), and HRV indices indicative of cardiac sympathetic activity were significantly high in individuals with CSU. In contrast, BRS and HRV indices indicative of parasympathetic activity and sleep quality were significantly low in these individuals. There was no significant correlation between SVB and other study parameters.
Patients with CSU have cardiac dysautonomia characterised by increased sympathetic activity and decreased parasympathetic activity. Also, the reduced BRS and increased RPP point towards an increased risk of CV morbidity in these individuals.
慢性应激是心脏自主神经功能障碍和心血管风险的潜在危险因素，已知会诱发慢性自发性荨麻疹（CSU）这一心理皮肤病的发作和加重。然而，关于与CSU相关的应激导致的心血管风险的数据非常有限。
本研究旨在比较CSU患者（试验组）和正常受试者（对照组）的心脏交感迷走平衡（SVB）、炎症标志物、感知应激和睡眠质量。此外，还旨在评估CSU患者中SVB与其他研究参数之间的相关性。
招募了34例CSU患者和28例年龄及性别匹配的健康对照者进行研究。按照标准程序评估心率变异性（HRV）、压力反射敏感性（BRS）以及应激和炎症的生化标志物（血清皮质醇、白细胞介素（IL）-6、IL-18和高敏C反应蛋白（hs-CRP））。使用预先验证的问卷评估感知应激和睡眠质量。使用独立样本t检验或曼-惠特尼U检验比较试验组和对照组之间的研究参数。使用斯皮尔曼等级相关系数检验评估SVB与其他研究参数之间的相关性。P<0.05被认为具有统计学意义。
CSU患者的感知应激水平、炎症标志物、平均动脉压（MAP）、心肌工作量（心率血压乘积（RPP））以及指示心脏交感神经活动的HRV指标显著升高。相比之下，这些患者中指示副交感神经活动和睡眠质量的BRS和HRV指标显著降低。SVB与其他研究参数之间无显著相关性。
CSU患者存在心脏自主神经功能失调，其特征为交感神经活动增加和副交感神经活动减少。此外，BRS降低和RPP升高表明这些个体发生心血管疾病的风险增加。
