Volterrani M, Scalvini S, Mazzuero G, Lanfranchi P, Colombo R, Clark A L, Levi G
Fondazione Clinica del Lavoro di Pavia, Gussago Medical Center, Italy.
Chest. 1994 Nov;106(5):1432-7. doi: 10.1378/chest.106.5.1432.
To evaluate possible autonomic nervous system (ANS) dysfunction in patients with chronic obstructive pulmonary disease (COPD) in the absence of any hypoxic neuronal damage, we studied 31 patients with COPD patients aged 31 to 68 years (55 +/- 10) and 32 age-matched healthy subjects (control). Respiratory function in the patients was as follows: FEV1 = 52 +/- 8 percent; PaO2 = 71 +/- 14 mm Hg; and PaCO2 = 40 +/- 10 mm Hg. The ANS was assessed by heart rate variability (HRV) in the time domain (SD of mean RR interval) and frequency domain (autoregressive spectral analysis recognizing low [LF] and high [HF] frequency components, vagal and sympathetic related, respectively). Patients and controls were evaluated at rest and during vagal (controlled breathing [CB]) and sympathetic (passive head-up tilt) maneuvers. Patients with COPD showed a depressed global HRV (rest SD = 34 +/- 20 ms vs 45 +/- 15 ms, p < 0.05; tilt SD = 28 +/- 14 ms vs 38 +/- 13, p < 0.01) with a predominant respiratory drive (rest HF = 44 +/- 28 vs 28 +/- 18, p < 0.05; tilt HF 42 +/- 28 vs 16 +/- 12, p < 0.01) as compared with normal subjects. In the control group, vagal and sympathetic responses were in opposite directions following a stimulus, whereas there was no significant HRV response in the COPD group. We conclude that patients with COPD have abnormalities of ANS function, with in particular a depressed HRV response to sympathetic and vagal stimuli.
为了评估慢性阻塞性肺疾病（COPD）患者在无任何缺氧性神经元损伤情况下可能存在的自主神经系统（ANS）功能障碍，我们研究了31例年龄在31至68岁（55±10岁）的COPD患者以及32例年龄匹配的健康受试者（对照组）。患者的呼吸功能如下：第一秒用力呼气容积（FEV1）=52±8%；动脉血氧分压（PaO2）=71±14毫米汞柱；动脉血二氧化碳分压（PaCO2）=40±10毫米汞柱。通过时域（平均RR间期的标准差）和频域（自回归谱分析，分别识别与迷走神经和交感神经相关的低频[LF]和高频[HF]成分）的心率变异性（HRV）来评估自主神经系统。在静息状态以及进行迷走神经（控制性呼吸[CB]）和交感神经（被动头高位倾斜）操作期间对患者和对照组进行评估。与正常受试者相比，COPD患者表现出整体HRV降低（静息标准差=34±20毫秒对45±15毫秒，p<0.05；倾斜标准差=28±14毫秒对38±13毫秒，p<0.01），且以呼吸驱动为主（静息HF=44±28对28±18，p<0.05；倾斜HF 42±28对16±12，p<0.01）。在对照组中，刺激后迷走神经和交感神经反应方向相反，而COPD组中HRV无显著反应。我们得出结论，COPD患者存在自主神经系统功能异常，尤其是对交感神经和迷走神经刺激的HRV反应降低。
