摘要目的:基于经颅多普勒(TCD)直立倾斜试验分析焦虑抑郁患者自主神经功能的特征。方法:选择2021年3月至2023年2月就诊于本院的焦虑抑郁患者80例,作为病例组,另选同期于本院体检的健康者80例,作为对照组。两组均接受TCD、直立倾斜试验与动态心电图(DCG)检查,对比两组W波回调不全发生率、直立倾斜试验血流动力学、TCD脑血流、心率变异性(HRV),Pearson相关性分析直立倾斜试验血流动力学、TCD脑血流与HRV的相关性,绘制ROC曲线分析TCD联合直立倾斜试验预测焦虑抑郁发生的价值。结果:与对照组比较,病例组W波回调不全发生率显著升高,有统计学差异(11.25% VS 0.00%,χ2=5.378,P=0.020);病例组倾斜直立位HR高于对照组,DBP、SV低于对照组(t=6.532、7.944、6.152,P均=0.000);病例组从平卧位至倾斜直立位的DBP、HR、SV变化绝对值高于对照组(t=12.015、6.644、5.635,P均=0.000);病例组倾斜直立位的Vd、Vs、Vm低于对照组,RI、PI高于对照组(t=10.488、3.927、11.256、2.298、5.918,P=0.000、0.000、0.000、0.023、0.000);病例组从平卧位至倾斜直立位的Vd、Vs、Vm、RI、PI变化绝对值高于对照组(t=9.559、10.943、10.775、10.738、28.236,P均=0.000);病例组LF、HF、PNN50、RMSSD、SDNN低于对照组(t=10.992、12.098、12.376、6.078、7.758,P均=0.000);Pearson相关性分析,从平卧位至倾斜直立位的DBP、HR、SV、Vd、Vs、Vm、RI、PI变化绝对值均与LF、HF、PNN50、RMSSD、SDNN呈负相关(r<0,P<0.05);绘制ROC曲线发现,从平卧位至倾斜直立位的DBP、HR、SV、Vd、Vs、Vm、RI、PI变化绝对值及联合预测焦虑抑郁的AUC分别为0.603、0.728、0.802、0.805、0.756、0.710、0.783、0.739、0.949。结论:TCD联合直立倾斜试验可有效预测焦虑抑郁发生,且二者可反映患者自主神经功能特征。
Abstract：Objective: To analyze the characteristics of autonomic nervous function in patients with anxiety and depression based on transcranial Doppler (TCD) upright tilt test.Methods: A total of 80 patients with anxiety and depression who were admitted to our hospital from March 2021 to February 2023 were selected as the case group, and another 80 healthy patients who underwent physical examination in our hospital during the same period were selected as the control group. Both groups underwent TCD, upright tilt test, and dynamic electrocardiogram (DCG) examinations. The occurrence rate of incomplete W wave rebound, hemodynamics during the upright tilt test, TCD cerebral blood flow, and heart rate variability (HRV) were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between hemodynamics during the upright tilt test, TCD cerebral blood flow, and HRV. ROC curve analysis was performed to evaluate the predictive value of TCD combined with the upright tilt test for the occurrence of anxiety and depression. Results: Compared with the control group, the incidence of W wave callback insufficiency in the case group was significantly higher, with a statistically significant difference (11.25 % VS 0.00 %, χ2=5.378, P=0.020). In the case group, HR in the upright tilt position was higher than that in the control group, while DBP and SV were lower (t=6.532, 7.944, 6.152, P all=0.000). The absolute values of changes in DBP, HR, and SV from the supine position to the upright tilt position were higher in the case group than in the control group (t=12.015, 6.644, 5.635, P all=0.000). Vd, Vs, Vm in the upright tilt position were lower, and RI, PI were higher in the case group compared to the control group (t=10.488, 3.927, 11.256, 2.298, 5.918, P=0.000, 0.000, 0.000, 0.023, 0.000). The absolute values of changes in Vd, Vs, Vm, RI, and PI from the supine position to the upright tilt position were higher in the case group than in the control group (t=9.559, 10.943, 10.775, 10.738, 28.236, P all=0.000). LF, HF, PNN50, RMSSD, SDNN were lower in the case group compared to the control group (t=10.992, 12.098, 12.376, 6.078, 7.758, P all=0.000). Pearson correlation analysis showed negative correlations between the absolute values of changes in DBP, HR, SV, Vd, Vs, Vm, RI, PI, and LF, HF, PNN50, RMSSD, SDNN from the supine position to the upright tilt position (r<0, P<0.05). ROC curve analysis revealed that the AUCs for the absolute values of changes in DBP, HR, SV, Vd, Vs, Vm, RI, PI, and the combined prediction of anxiety and depression from the supine position to the upright tilt position were 0.603, 0.728, 0.802, 0.805, 0.756, 0.710, 0.783, 0.739, and 0.949, respectively. Conclusion: TCD combined with upright tilt test can effectively predict the occurrence of anxiety and depression, and both can reflect the characteristics of autonomic nervous function in patients.
张亚雯, 陈文敏, 郭晓云. 基于经颅多普勒直立倾斜试验分析焦虑抑郁患者自主神经功能的特征[J]. 河北医学, 2024, 30(3): 493-498.
ZHANG Yawen, et al. Characteristics of Autonomic Nervous Function in Patients with Anxiety and Depression Analyzed by Transcranial Doppler Upright Tilt Test. HeBei Med, 2024, 30(3): 493-498.
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2024, Vol. 30 
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