长新冠综合征患者的自主神经功能降低是由心肺适能介导的。

Reduced autonomic function in patients with long-COVID-19 syndrome is mediated by cardiorespiratory fitness.

机构信息

Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España.

Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.

出版信息

Curr Probl Cardiol. 2024 Sep;49(9):102732. doi: 10.1016/j.cpcardiol.2024.102732. Epub 2024 Jul 1.

DOI:10.1016/j.cpcardiol.2024.102732

PMID:38960014

Abstract

BACKGROUND

Long-COVID-19 syndrome (LCS) exhibits neurological problems such as peripheral neuropathy and autonomic nervous system (ANS) dysfunction. Exercise intolerance and, consequently, low cardiorespiratory fitness (CRF) are some of the most common symptoms of LCS. We describe a series of individuals exhibiting LCS symptoms compared to a control group and posit that this condition may be related to the exercise capacity-mediated disruption of the ANS resulting particularly in exercise intolerance.

METHODS

This study included 87 individuals with LCS and 71 control participants without COVID-19 diagnoses. Heart rate variability (HRV) in supine position is commonly measured to diagnose autonomic dysregulation and subsequently analyzed using the Kubios software (Kuopio, Finland). CRF (peak VO), post-COVID-19 patient-reported symptoms, maximal muscle strength (grip strength, bilateral leg press, leg extension, pectoral press, and back press exercises), and body composition were also measured. Analysis of covariance (ANCOVA) and mediation analysis were employed to assess the associations among LCS, peak VO, and HRV indicators. Two-sided p < 0.05 was considered as significant.

RESULTS

The HRV parameters-RR interval, RMSSD, SDNN, PNS index, LF, HF, total power, SD1, and SD2-were significantly elevated (p < 0.05) in the control group when compared to the LCS patients. In contrast, the HR, stress index, and SNS index parameters were significantly higher (p < 0.05) in the LCS group. When adjusted for RR intervals, these parameters remained statistically significant (p < 0.05). A partially mediated effect was found between peak VO and RMSSD (mediation effect = 24.4%) as well as peak VO and SDNN (mediation effect = 25.1%) in the LCS patients.

CONCLUSIONS

These findings contribute new insights on the interplay between CRF and HRV indicators as well as endorse that dysautonomia may be related to the low peak VO observed in long COVID-19 patients.

摘要

背景

长新冠综合征（LCS）表现出外周神经病变和自主神经系统（ANS）功能障碍等神经系统问题。运动不耐受，以及随之而来的心肺功能（CRF）低，是 LCS 的一些最常见症状。我们描述了一系列表现出 LCS 症状的个体，并提出这种情况可能与运动能力介导的 ANS 中断有关，特别是导致运动不耐受。

方法

这项研究包括 87 名 LCS 患者和 71 名没有 COVID-19 诊断的对照组参与者。通常使用仰卧位心率变异性（HRV）来诊断自主神经失调，然后使用 Kuopio 软件（芬兰库奥皮奥）进行分析。还测量了 CRF（峰值 VO）、新冠后患者报告的症状、最大肌肉力量（握力、双侧腿部按压、腿部伸展、胸部按压和背部按压练习）和身体成分。采用协方差分析（ANCOVA）和中介分析来评估 LCS、峰值 VO 和 HRV 指标之间的关联。双侧 p<0.05 被认为具有统计学意义。

结果

与 LCS 患者相比，对照组的 HRV 参数-RR 间隔、RMSSD、SDNN、PNS 指数、LF、HF、总功率、SD1 和 SD2-显著升高（p<0.05）。相反，HR、应激指数和 SNS 指数参数在 LCS 组中显著升高（p<0.05）。在调整 RR 间隔后，这些参数仍然具有统计学意义（p<0.05）。在 LCS 患者中，发现峰值 VO 与 RMSSD 之间存在部分中介效应（中介效应=24.4%）以及峰值 VO 与 SDNN 之间存在部分中介效应（中介效应=25.1%）。