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目的探讨胰腺癌病人心率变异性(HRV)的变化及其在临床中的价值。方法回顾性分析2008年1月至2013年5月浙江大学医学院附属第二医院收治的518例胰腺癌病人临床资料。以性别、年龄、癌症分期及癌症是否远处转移分组,对比不同组内的HRV指标,包括全部正常窦性心搏间期的标准差(SDNN)和全部相邻RR间期之差的均方根(r RMSSD)。以SDNN=20 ms为界分为低HRV组和高HRV组,比较两组间C反应蛋白(CRP)及肿瘤直径的统计学意义。结果胰腺癌早期病人、胰腺癌未转移病人的HRV值分别高于胰腺癌晚期病人(P<0.001)及胰腺癌已转移病人(P=0.011)HRV值,并且在低HRV组中观察到CRP显著升高(P=0.008)。结论胰腺癌的恶性程度与HRV的水平变化有关,低HRV的病人预后较差,这可能与迷走神经兴奋抑制炎性反应的机制有关。
Objective To investigate the changes of heart rate variability (HRV) in patients with pancreatic cancer and its clinical value. Methods The clinical data of 518 patients with pancreatic cancer admitted to the Second Affiliated Hospital of Zhejiang University from January 2008 to May 2013 were retrospectively analyzed. Patients were divided into groups according to sex, age, stage of cancer and cancer. The HRV indexes of different groups were compared, including the standard deviation of all normal sinus beats (SDNN) and the root mean square of the difference between all adjacent RR intervals r RMSSD). With SDNN = 20 ms as a borderline, the patients were divided into low HRV group and high HRV group, and the statistical significance of C-reactive protein (CRP) and tumor diameter was compared between the two groups. Results The HRV values of patients with early pancreatic cancer and those without metastasis of pancreatic cancer were significantly higher than those of patients with advanced pancreatic cancer (P <0.001) and patients with metastatic pancreatic cancer (P = 0.011), respectively, and CRP was significantly lower in patients with low HRV Increased (P = 0.008). Conclusions The degree of malignancy of pancreatic cancer is related to the level of HRV. The prognosis of patients with low HRV is poor, which may be related to the mechanism of excitability of vagus nerve inhibiting inflammatory reaction.