摘要
目的 探讨失独所致创伤后应激障碍(PTSD)患者心率变异性(HRV)的改变,并通过ROC曲线分析PTSD异常的HRV指标在鉴别PTSD和非PTSD患者中的价值。方法 收集2021年1月至2022年12月江苏省收治的26例失独且伴有PTSD患者(PTSD组)、18例失独无PTSD患者(NPTSD组)和28例健康志愿者(HC组),对其行短时HRV检测,主要监测时域指标有:正常窦性R-R间期标准差(SDNN)、全过程相邻R-R间期之差的均方根(RMSSD)、相邻R-R间期差值>50 ms的百分比(PNN50);主要监测频域指标有:总能量(TP)、低频功率(LF)、高频功率(HF)、LF/HF。使用方差分析观察3组受试者间HRV指标的差异,利用Pearson相关分析探究HRV指标与PTSD严重程度的相关性,并通过ROC曲线分析PTSD组与NPTSD组差异HRV指标在其鉴别诊断中的价值。结果 时域指标中,PTSD组SDNN和RMSSD[(128.85±68.00)ms、(173.15±87.24)ms]较NPTSD组[(83.33±45.07)ms、(112.22±64.78)ms]和HC组[(104.13±59.43)ms、(126.75±68.60)ms]显著升高,NPTSD组SDNN和RMSSD较HC组降低;频域指标中,PTSD组TP和HF(4383.82±7407.68、1836.65±3351.77)较NPTSD组(1608.57±1773.52、810.71±966.41)和HC组(1773.78±2752.45、776.64±1134.60)显著升高,差异均有统计学意义(P<0.05)。HRV指标与PTSD症状的严重程度无显著相关性。ROC曲线分析示SDNN和RMSDD在鉴别PTSD与NPTSD的患者中具有较高的区分价值。其中,SDNN的曲线下面积为0.72(95%CI 0.57~0.87),界值为103.5 ms时敏感度为62%,特异度为72%;RMSDD的曲线下面积为0.73(95%CI 0.57~0.88),界值为88.5 ms时敏感度为92%,特异度为50%。结论 失独所致PTSD可引起失独被试异常HRV升高,可能是患者自主神经张力异常及调节功能失衡的病理基础。HRV指标的改变似可用于PTSD的早期诊断。
Objective The aim of this study is to explore the alteration of heart rate variability(HRV)in patients with Post-traumatic stress disorder(PTSD)caused by the loss of the only child,and to explore its value in distinguishing PTSD and non-PTSD patients via receiver operator characteristic(ROC)curve.Methods 26 patients with PTSD(the PTSD group),18 patients without PTSD(the NPTSD group)and 28 healthy volunteers(the HC group)who were treated in Jiangsu Province from January 2021 to De-cember 2022.Short-term HRV testing was performed on them.The main monitoring time domain indicators include:standard deviation of normal sinus R-R interval(SDNN),root mean square difference between adjacent R-R intervals in the whole process(RMSSD),and the percentage of adjacent R-R interval differences>50 ms(PNN50);the main monitoring frequency domain indicators are:total energy(TP),low frequency power(LF),high frequency power(HF),and LF/HF.HRV indicators were compared with analysis of variance test to observe the difference amongthe three groups;Pearson's correlation was used to explore the correlationbetween HRV in-dicators and the severity of PTSD;ROC curve was used to analyze the value of HRV indicators in the differential diagnosis of PTSD and NPTSD.Results Among the time-domain indicators,SDNN and RMSSD[(128.85±68.00)ms,(173.15±87.24)ms]in the PTSD group were significantly higher than those in the NPTSD group[(83.33±45.07)ms,(112.22±64.78)ms]and the HC group[(104.13±59.43)ms,(126.75±68.60)ms],while the SDNN and RMSSD in the NPTSD group were lower than those in the HC group.In frequency-domain indicators,TP and HF(4383.82±7407.68,1836.65±3351.77)of the PTSD group were significantly higher than those of the NPTSD(1608.57±1773.52,810.71±966.41)and the HC groups(1773.78±2752.45,776.64±1134.60),and the difference was statistically significant(P<0.05).There was no significant correlation between HRV indicators and the severity of PTSD symptoms.ROC analysis demonstrated the SDNN and RMSSD were effective in identifying between
作者
刘想
戚荣丰
卢光明
罗一烽
张理义
汪长岭
汤黎明
沈华强
冯文熙
张丽
曹志宏
LIU Xiang;QI Rongfeng;LU Guangming;LUO Yifeng;ZHANG Liyi;WANG Changling;TANG Liming;SHEN Huaqiang;FENG Wenxi;ZHANG Li;CAO Zhihong(School of Medical Imaging Xuzhou Medical University,Xuzhou 221004,Jiangsu,China;Department of Radiology,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Radiology,the Affiliated Yixing Hospital of Jiangsu University,Wuxi 214200,Jiangsu,China;Mental Diseases Prevention and Treatment Center of PLA,the 904th Hospital of the Joint Logistics Support Force,PLA,Changzhou 213003,Jiangsu,China;Department of Medical Engineering,General Hospital of Eastern Theater Command,PLA,Nangjing 210002,Jiangsu,China;Mental Health Institute,the Second Xiangya Hospital,National Technology Institute of Psychiatry,Changsha 410011,Hunan,China)
出处
《医学研究与战创伤救治》
CAS
北大核心
2023年第10期1034-1039,共6页
Journal of Medical Research & Combat Trauma Care
基金
江苏省自然科学基金(BK20221554)
江苏省社会发展项目(BE2022705)
南京师范大学“心理健康与认知科学”省重点实验室开放课题基金(23MHCSKF01)。
关键词
失独
创伤后应激障碍
心率变异性
自主神经功能
Shidu
post traumatic stress disorder
heart rate variability
autonomic nervous function
