类风湿性关节炎患者自主神经功能的临床观察*

The clinical observation of autonomic nerve function in patients with rheumatoid arthritis*

摘要:

目的：观察类风湿关节炎患者心率变异的变化，并探究其与疾病相关指标的关系。方法：根据纳排标准选出类风湿关节炎（rheumatoid arthritis，RA）患者71例作试验组，同时选择年龄，性别等基本信息相匹配的健康成年人80例作对照组，入院当天评估试验组患者视觉模拟评分（visual analogue scale，VAS），疾病活动度评分DAS28及焦虑自评量表（Self-Rating Anxiety Scale，SAS），在相同环境下通过心率变异检测仪获取所有受试对象心率变异频域（Very Low Frequency，VFL；Low Frequency，LF；High Frequency，HF；Total Frequency，TP）及时域（Standard deviation of all normal-to-normal QRS intervals，SDNN）参数 ，并于第二日清晨空腹抽血检查试验组患者相关自身抗体及炎症指标。结果：RA患者所有HRV参数均较健康对照组明显降低，疼痛程度的增加及焦虑情绪的存在会进一步降低RA患者的HRV， RA患者RF与HF呈显著负相关。除VLF外其余HRV指标与年龄，VAS，DAS28呈负相关，所有HRV指标均与hs-CRP及ESR呈负相关。结论：RA患者存在自主神经功能的紊乱，HRV有助于对RA患者进行综合评估。

Abstract:

Objective：Observe the changes of heart rate variability in patients with rheumatoid arthritis and explore its relationship with disease-related indicators. Methods：According to the criteria for inclusion and exclusion, 71 patients with rheumatoid arthritis(RA)were selected as the test group, and 80 healthy adults with matching basic information such as age and gender were selected as the control group. Evaluation of visual analogue scale (VAS), Self-Rating Anxiety Scale(SAS) and disease activity score28 (DAS28) in the test group on the day of admission, all subjects were test by the heart rate variability (HRV) detector in the same environment, And get time domain（Very Low Frequency，VFL；Low Frequency，LF；High Frequency，HF；Total Frequency，TP）and frequency domain（Standard deviation of all normal-to-normal QRS intervals，SDNN）parameters, In the early morning of the second day, blood was drawn to check the relevant indicators of the RA patient. Results：All HRV parameters of RA patients were significantly lower than those of healthy control group, and increase of pain and anxiety will further reduce the HRV of RA patients. RF was negatively correlated with HF in RA patients. All HRV parameters except VLF were negatively correlated with age, VAS and DAS28 of RA patients, all HRV parameters were negatively correlated with hs-CRP and ESR. Conclusion：Autonomic dysfunction exists in RA patients, and HRV is helpful for comprehensive evaluation of RA patients.