JAMA Psychiatry:低心率变异性与创伤后应激障碍表现密切相关

2015-09-11 MedSci MedSci原创

尽管既往研究认为低心率变异性与创伤后应激障碍(PTSD)之间存在关联,但是具体细节尚未可知。加州大学圣地亚哥医学院(UCSD)和圣地亚哥退伍军人医院的研究人员发现,心率变异性较低可能导致远离战场的退伍军人患创伤后应激障碍(PTSD)的风险增加,并将文章发表在JAMA Psychiatry。 心率变异性是指逐次心搏间期的微小差异,它产生于自主神经系统对心脏窦房结的调制,使得心搏间期一般存在几十毫秒的

尽管既往研究认为低心率变异性与创伤后应激障碍(PTSD)之间存在关联,但是具体细节尚未可知。加州大学圣地亚哥医学院(UCSD)和圣地亚哥退伍军人医院的研究人员发现,心率变异性较低可能导致远离战场的退伍军人患创伤后应激障碍(PTSD)的风险增加,并将文章发表在JAMA Psychiatry。 


心率变异性是指逐次心搏间期的微小差异,它产生于自主神经系统对心脏窦房结的调制,使得心搏间期一般存在几十毫秒的差异和波动。反映自主神经系统活性、定量评估心脏交感神经与迷走神经张力及其平衡性,从而判断其对心血管疾病的病情及预防,可能是预测心脏性猝死和心律失常性事件的一个有价值的指标。当迷走神经活性增高或交感神经活性减低时,心率变异性增高,反之相反。一般来说,高心率变异性意味着机体功能正常。

心率变异性低反应机体存在一定的健康问题,例如哮喘、抑郁和心脏病、胎儿窘迫和糖尿病神经病变等。新近研究也证实了低心率变异性会导致机体出现创伤后应激障碍。 

PTSD的临床表现包括重复记忆或反复出现噩梦、情绪较易激动、失眠、对生活丧失兴趣和激情、抑郁、感觉迟钝、易怒和滥用药物。

参加过战争的军人易出现创伤后应激障碍。9%参加过越南战争的美国退伍军人患有创伤后应激障碍。经历过伊拉克和阿富汗战争的退伍军人患PTSD的几率为13-15%。患PTSD的美国民众占8%,以上两个数字明显高于这个数字。 

在他们的研究中,研究人员在2008年7月到2013年10月跟踪调查了现役美国海军陆战队军人。作战部署之前1-2个月对他们的心率变异性进行评估,当他们退伍4-6个月后继续进行心率变异性评估。 

结果表明,美国海军陆战队的军人作战前若心率变异性较低,则他们患PTSD的可能性更高。

Arpi Minassian博士认为,自主神经系统的改变有可能影响民众的精神承受能力和患PTSD的恢复状况。"这表明,自主神经系统状态的改变可能导致的脆弱性和恢复力PTSD,连同已知的危险因素,如战斗暴露和既存的压力和创伤的症状。” 

研究人员表示,如果这些初步结果在进一步的研究中得以证实,他们可能会采取相应措施作用于机体自主神经系统,并以此治疗患者出现的创伤后应激障碍症状。

原始出处:

Association of predeployment heart rate variability with risk of postdeployment posttraumatic stress disorder in active-duty marines, Arpi Minassian et al., JAMA Psychiatry,  9 Sep 2015.

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