Heart rate variability for evaluation of ACTH and serum cortisol associated with Cushing's dis-ease during perioperative period
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目的 探讨库欣病(cushing's disease,CD)患者围手术期激素水平与心率变异性(heart rate variabili-ty,HRV)波动的相关性.方法 采用前瞻性病例对照研究设计,选取拟行"内镜下经鼻蝶入路垂体瘤切除术"的CD患者30例作为观察组,同期选取无功能性垂体腺瘤(nonfunctioning pituitary adenoma,NFPA)患者28例作为对照组.术前评估两组患者焦虑、抑郁及觉知压力水平,术后分别于术前及术后首日采集患者8:00血清皮质醇、血浆促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)水平,以及术前一日、术日夜间睡眠状态的HRV指标.比较分析两组患者激素水平变化与HRV的变化差异.结果 CD患者均在接受"内镜下经鼻蝶入路垂体瘤切除术"后达到"生化缓解",血清皮质醇与ACTH较术前显著下降(P＜0.05),HRV参数的低频功率(Low frequency power,LF)和 RR 间期标准差(standard deviation of normal RR interval,SDNN)较术前增高(P＜0.05);NFPA 患者皮质醇、ACTH和HRV参数手术前后均无显著变化(P＞0.05).结论 HRV指标中LF和SDNN是反映库欣病患者术后"生化缓解"的一个潜在临床指标.
Objective To investigate the correlation effect of changes in Heart Rate varia-bility(HRV)and hormone associated with Cushing's Disease during perioperative period.To ex-plore a credible,effective and convenient monitoring indicator for patients with Cushing's Disease after the endoscopic endonasal surgery.Methods 30 patients with CD and 28 age,gender,BMI,blood pressure,fasting blood glucose and course of disease matched patients with nonfunctioning pituitary adenoma(NFPA)participated in the study.All the patients were investigated by using the Hospital Anxiety and Depression Scale(HADS)and Chinese perceived stress scale(CPSS)be-fore operation.During perioperative period,All the patients were obtained the level of plasma ACTH and cortisol.HRV assessment was made in both time and frequency domain using the ex-tracted RR interval data when patients in sleep.Results All the patients with CD achievedbio-chemical remission.The low frequency(LF)and SD of all the RR intervals(SDNN)of patients with CD after operation were significantly(P＜0.05)higher than those before operation.There were no significant changes in HRV and hormone of patients with NFPA during perioperative pe-riod.Conclusion The LF and SDNN may be an effective indicator on patients with CD who at-tained biochemical remission after the endoscopic endonasal surgery.
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