运动诱发性支气管痉挛的儿童和青少年是否存在心脏自主神经功能障碍？
Is there cardiac autonomic dysfunction in children and adolescents with exercise-induced bronchospasm?
作者信息
Chaves Quirino Polyanna Guerra, Rizzo José Ângelo, Hunter Steve, de Albuquerque Rodrigues Filho Edil, Sarinho Emanuel, de Almeida Santos Camila Matias, Medeiros Decio, Costa Emilia Chagas, Silva Alexandre Sérgio, Farah Breno Quintella, de Valois Correia Júnior Marco Aurélio
机构信息
Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil.
Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil.
出版信息
Expert Rev Respir Med. 2023 Jul-Dec;17(9):823-831. doi: 10.1080/17476348.2023.2265819. Epub 2023 Oct 27.
BACKGROUND
The pulmonary impairment in patients with bronchoconstriction induced by eucapnic voluntary hyperpnea(EVH) goes beyond the respiratory system, also impairing autonomic nervous modulation. This study aimed to evaluate the behavior of cardiac autonomic modulation in young asthmatics with and without EIB after the EVH test.
RESEARCH DESIGN AND METHODS
A cross-sectional study design using 54 asthmatics(51.9% female), aged between 10 and 19 years, investigated with the EVH test. Forced expiratory volume in one second(FEV) was measured at 5, 10, 15, and 30 min after EVH. Heart rate variability(HRV) measures of time were assessed pre and 30 min-post EVH. The diagnosis of Exercise-Induced bronchoconstriction with underlying clinical asthma(EIB) was confirmed by a fall in FEV ≥10% compared to baseline.
RESULTS
Thirty(55.5%) asthmatics had EIB. Subjects with EIB have reduced mean of the R-R intervals in relation to baseline until 15 minutes after EVH. Individuals without EIB had increased parasympathetic activity compared to baseline(rMSSD) from 5 min after EVH( < 0.05). This parasympathetic activity increase in relation to baseline was seen in individuals with EIB after 25 minutes (rMSSD = 49.9 ± 5.3 63.5 ± 7.2, < 0.05).
CONCLUSION
Young asthmatics with EIB present a delay in the increase of the parasympathetic component after EVH when compared to asthmatics without EIB.
背景
等二氧化碳通气过度（EVH）诱发支气管收缩患者的肺功能损害不仅局限于呼吸系统，还会损害自主神经调节。本研究旨在评估EVH试验后有或无运动诱发支气管痉挛（EIB）的年轻哮喘患者心脏自主神经调节的表现。
研究设计与方法
采用横断面研究设计，对54名年龄在10至19岁之间的哮喘患者（51.9%为女性）进行EVH试验。在EVH后5、10、15和30分钟测量一秒用力呼气容积（FEV）。在EVH前和后30分钟评估心率变异性（HRV）的时间指标。与基线相比，FEV下降≥10%可确诊为运动诱发支气管痉挛合并潜在临床哮喘（EIB）。
结果
30名（55.5%）哮喘患者患有EIB。患有EIB的受试者在EVH后15分钟内，与基线相比，R-R间期平均值降低。与基线相比，无EIB的个体在EVH后5分钟时副交感神经活动增加（rMSSD，P<0.05）。25分钟后，患有EIB的个体与基线相比，副交感神经活动也出现增加（rMSSD = 49.9±5.3对63.5±7.2，P<0.05）。
结论
与无EIB的哮喘患者相比，患有EIB的年轻哮喘患者在EVH后副交感神经成分增加出现延迟。
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