Liau Matthias Yi Quan, Liau Jovan Yi Jun, Selvakumar Surya Varma, Chan Kai Siang, Shelat Vishalkumar Girishchandra
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Transl Gastroenterol Hepatol. 2024 Aug 21;9:68. doi: 10.21037/tgh-24-22. eCollection 2024.
Acute pancreatitis (AP) is a complex inflammatory disorder with potential systemic repercussions including sepsis, multiple organ failure and mortality. As such, the development of a prognostic tool to assess the complications and severity of AP is critical as urgent medical intervention is warranted in cases of severe AP to prevent complications and reduce mortality. Despite the plethora of scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score available for prognostication of AP, they often require manual invasive blood testing and lack the ability to monitor the dynamic progression of the disease. To this end, heart rate variability (HRV), a measure of the autonomic nervous system's modulation on cardiac activity, has emerged as a promising tool. Having been previously posited as a tool to monitor the progression of cardiovascular and neurological conditions, the use of HRV as a risk stratification tool for AP is highly plausible. Therefore, this study aims to synthesize the existing literature regarding the usage of HRV as a tool for the prognostication and monitoring of AP.
A comprehensive literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and Embase from inception to December 2023. Articles with mentions of AP and HRV were reviewed, and the complications of AP and its effects on HRV parameters were analyzed.
Early studies on the use of HRV in AP have revealed the association of decreased HRV parameters with the development of subsequent complications, reflecting the suppression of sympathetic activity as a predominant driving force. In addition, HRV has also been shown to outperform other established scoring systems in predicting outcomes of the complications of AP, but more studies are needed to validate its accuracy.
Preliminary studies have shown that certain parameters of HRV may be used to predict the severity of AP and prognosticate outcomes. Although HRV monitoring demonstrates potential to be superior to existing scoring systems in AP, more research is needed to validate its use as a prognostic tool. Nevertheless, the prospective utility of HRV monitoring in predicting the onset and outcomes of AP and its complications remains optimistic.
急性胰腺炎（AP）是一种复杂的炎症性疾病，具有潜在的全身影响，包括败血症、多器官功能衰竭和死亡。因此，开发一种评估AP并发症和严重程度的预后工具至关重要，因为对于重症AP病例，需要紧急医疗干预以预防并发症并降低死亡率。尽管有大量的评分系统，如急性生理与慢性健康评估II（APACHE II）评分可用于AP的预后评估，但它们通常需要进行侵入性的手动血液检测，并且缺乏监测疾病动态进展的能力。为此，心率变异性（HRV），一种衡量自主神经系统对心脏活动调节的指标，已成为一种有前景的工具。此前已有人提出将HRV作为监测心血管和神经系统疾病进展的工具，将HRV用作AP的风险分层工具是非常合理的。因此，本研究旨在综合现有关于将HRV用作AP预后和监测工具的文献。
从创刊至2023年12月，在PubMed、Cochrane对照试验中心注册库（CENTRAL）、科学网、Scopus和Embase中进行了全面的文献检索。对提及AP和HRV的文章进行了综述，并分析了AP的并发症及其对HRV参数的影响。
早期关于在AP中使用HRV的研究表明，HRV参数降低与随后并发症的发生有关，这反映了交感神经活动的抑制是主要驱动力。此外，HRV在预测AP并发症的结果方面也被证明优于其他既定的评分系统，但需要更多的研究来验证其准确性。
初步研究表明，HRV的某些参数可用于预测AP的严重程度和预后结果。尽管HRV监测在AP中显示出优于现有评分系统的潜力，但需要更多的研究来验证其作为预后工具的用途。然而，HRV监测在预测AP及其并发症的发作和结果方面的前瞻性效用仍然乐观。
