Malaspina D, Bruder G, Dalack G W, Storer S, Van Kammen M, Amador X, Glassman A, Gorman J
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Biol Psychiatry. 1997 Mar 1;41(5):612-7. doi: 10.1016/s0006-3223(96)00161-8.
We measured high-frequency (rapid) heart rate variability (HRV) from 24-hour Holter electrocardiograms to index cardiovagal tone in 23 patients with DSM-III-R schizophrenia or schizoaffective disorder. High-frequency HRV, quantitated by measuring the percent of successive normal interbeat intervals greater than 50 msec (PNN50), demonstrated a bimodal distribution: 11 of 23 patients had a PNN50 of > and = 8.0 (mean value = 17.7 +/- 11.0), and 12 had a PNN50 of < and = 4.0 (mean value = 1.8 +/- 1.0); no subject had a PNN50 value between 4.0 and 8.0. All 12 low cardiovagal tone patients (versus only 6/11 of the other patients) had a schizophrenia (not schizoaffective) diagnosis (p = .013). PNN50 was not associated with present age, gender, smoking, IQ scores, or symptomatology, but patients with lower cardiovagal tone did have a significantly later age of onset (20.5 +/- 5.3 vs. 14.8 +/- 2.8 years: p = .005). PNN50 subgroups also differed on dichotic listening measures of brain laterality. The low group failed to show left ear (right hemisphere) advantage for complex tones seen in the other patients and normal adults. They also showed larger right ear (left hemisphere) advantage for dichotic words than the other patients. This evidence of relative right hemisphere disadvantage in patients with low cardiovagal tone is consistent with findings linking autonomic nervous system and right hemisphere function. These findings also support the existence of subgroups of schizophrenia patients differing in autonomic activity, brain laterality, and clinical features.
我们通过24小时动态心电图测量了23例符合DSM - III - R精神分裂症或分裂情感性障碍诊断标准的患者的高频（快速）心率变异性（HRV），以此来评估心脏迷走神经张力。高频HRV通过测量连续正常心搏间期大于50毫秒的百分比（PNN50）进行量化，结果显示出双峰分布：23例患者中，11例的PNN50≥8.0（平均值 = 17.7±11.0），12例的PNN50≤4.0（平均值 = 1.8±1.0）；没有患者的PNN50值介于4.0和8.0之间。所有12例心脏迷走神经张力低的患者（相对于其他患者中的6/11）被诊断为精神分裂症（而非分裂情感性障碍）（p = 0.013）。PNN50与当前年龄、性别、吸烟、智商分数或症状学无关，但心脏迷走神经张力较低的患者起病年龄显著更晚（20.5±5.3岁 vs. 14.8±2.8岁：p = 0.005）。PNN50亚组在大脑半球优势的双耳分听测量方面也存在差异。低PNN50组在复杂音调上未表现出其他患者及正常成年人中可见的左耳（右半球）优势。他们在双耳分听单词时，右耳（左半球）优势也比其他患者更大。心脏迷走神经张力低的患者相对右半球功能劣势的这一证据与自主神经系统和右半球功能相关的研究结果一致。这些发现也支持了精神分裂症患者中存在自主神经活动、大脑半球优势及临床特征不同的亚组。
