采用心率变异性分析抗胆碱能药物治疗前后哮喘患者自主神经变化的初步探讨

发布时间：2018-06-03 23:10

本文选题：支气管哮喘 + 心率变异性　；参考：《昆明医科大学》2013年硕士论文

【摘要】：目的 (1)采用动态心电图分析软件中的心率变异性的定量指标(LF、HF、SDANN、 pNN50)来观察支气管哮喘(bronchial asthma,简称哮喘)患者与健康对照组自主神经功能的变化,探讨哮喘患者是否存在着自主神经功能紊乱。 (2)使用长效抗胆碱能药物噻托溴铵治疗哮喘患者6周,再次使用心率变异性(HRV)中的定量指标(LF、HF、SDANN、pNN50)分析患者的自主神经功能变化,与用药前对比是否有统计学意义,同时观察肺功能中的FEV1、FEV1%指标,用药后每日使用短效p2-受体激动剂(沙丁胺醇气雾剂)的次数,日间、夜间哮喘症状评分等相关指标,探讨长效抗胆碱能药物噻托溴铵能否从神经调节机制上安全、有效的用于哮喘的治疗,为哮喘防治提供一种新思路。方法 (1)以非急性发作期的30-45岁之间的45例中度持续哮喘随机分为B、C、D三组,B组为ICS+LAMA;C组为ICS+LABA;D组为ICS+LAMA+LABA；选用三组中任意的一组B组和15例健康对照组即A组对比研究,运用动态心电图监测得出心率变异性的定量分析指标LF、HF、SDANN、pNN50同时使用肺功能仪肺功能计量器(Ms-PFT;Jaeger:Analyzer,Unit)测定其第一秒用力呼气容积(forced expiratory volume in one second, FEV1)、第一秒用力呼气容积占预计值的百分比(forced expiratory volume in one second/predicated value, FEV1%);根据哮喘症状评分表得出哮喘患者的日间、夜间哮喘症状评分及每日使用短效β2-受体激动剂的次数。 (2)C、D两组哮喘患者同样运用上述(1)中方法得出心率变异性的定量分析指标LF.HF.SDANN.pNN50；肺功能FEV1、FEV1%:日间、夜间哮喘症状评分及每日使用短效p2-受体激动剂的次数。 (3)B、C、D三组哮喘患者(B组为ICS+LAMA:C组为ICS+LABA:D组为ICS+LAMA+LABA)按照治疗方案给予6周治疗后,再次运用动态心电图监测得出治疗后的心率变异性定量分析指标LF.HF.SDANN.pNN50；同时使用肺功能仪肺功能计量器测定其治疗后的FEV1、FEV1%;根据哮喘症状评分表得出哮喘患者治疗后的日间、夜间哮喘症状评分及每日使用短效β2-受体激动剂的次数。 (4)ICS—丙氟酸氟替卡松气雾剂(商品名：辅舒酮,葛兰素史克公司生产,规格：125微克)每天2次,早晚各2次吸入；ICS+LABA—沙美特罗替卡松干粉剂(商品名：舒利迭,葛兰素史克公司生产,规格50/250微克)每天2次,早晚各1次吸入：LAMA—噻托溴铵粉吸入剂(浙江仙琚制药公司生产,规格：18微克)吸入,每日一次；硫酸沙丁胺醇气雾剂(商品名：万托林,葛兰素史克公司生产,规格：100微克)按需使用。结果 1、支气管哮喘患者与健康对照组比较,即B组与A组,反映副交感神经的HF、pNN50增高,反映交感神经的LF、SDANN降低,与正常对照组有差异性(P0.05)。2、B、C、D三组哮喘患者使用药物治疗6周后,B组的HF、pNN50降低,与用药前对比差异有统计学意义,LF、SDANN增高,差异无统计学意义；C组HF、pNN50降低,LF、SDANN增高,但与用药前对比差异均无统计学意义；D组HF、pNN50降低,LF、SDANNB增高,与用药前对比差异均有统计学意义。三组的日间、夜间症状评分较用药前有所降低,使用短效p2-受体激动剂的次数减少,肺功能中的FEV1、FEV1%较用药前改善,三组与治疗前对比差异均有统计学意义。 3、B、C、D三组哮喘患者使用药物治疗6周后,组间对比得出心率变异性的定量分析指标(HF、pNN50、LF、SDANN),B组与C组、C组与D组差异有统计学意义,B组与D组差异无统计学意义；肺功能中的FEV1、FEV1%显示B组与C组差异无统计学意义,而B组与D组、C组与D组差异均有统计学意义；日间、夜间症状评分、使用短效p2-受体激动剂的次数显示B组与C组差异无统计学意义,B组与D组、C组与D组差异有统计学意义。结论 (1)非急性发作期的中度持续支气管哮喘患者存在自主神经功能紊乱,表现为反映副交感神经兴奋性的HF、PNN50增加,反映交感神经兴奋性的LF、SDANN降低。 (2)长效抗胆碱能药物噻托溴铵粉吸入剂联合糖皮质激素组可以降低HF、PNN50,使副交感神经兴奋性降低；在改善自主神经功能紊乱方面,抗胆碱能药物联合糖皮质激素组优于长效β2-受体激动剂联合糖皮质激素组；在减轻哮喘症状方面及改善肺功能方面二者效果相当；以上三种药物联合使用在改善肺功能、降低心率变异性、降低哮喘症状评分及使用短效β2-受体激动剂次数等方面均表现出更加优越的临床疗效。
[Abstract]:objective
(1) the quantitative indexes of heart rate variability (LF, HF, SDANN, pNN50) in the dynamic electrocardiogram analysis software were used to observe the changes of autonomic nervous function in the patients with bronchial asthma (bronchial asthma) and the healthy control group, and to explore the existence of autonomic nervous dysfunction in the patients with asthma.
(2) the use of the long effect anticholinergic drug thiotropium bromide in the treatment of asthmatic patients for 6 weeks, again using the quantitative index of heart rate variability (HRV) (LF, HF, SDANN, pNN50) to analyze the changes in autonomic nervous function of the patients, whether there is a statistical significance compared with the pre medication, and observe the FEV1, FEV1% index in the lung function, and use the short acting p2- daily after the drug use. The frequency of the body agonist (Salbutamol Aerosol), the day, and the symptoms of asthma at night are related to the safety of the long effect anticholinergic drug thiotropium bromide from the neuromodulation mechanism, effectively used in the treatment of asthma, and provide a new way of thinking for the prevention and treatment of asthma.
Method
(1) 45 cases of moderate persistent asthma at the age of 30-45 years were randomly divided into B, C, D three, group B ICS+LAMA, C group ICS+LABA, and D group ICS+LAMA+LABA, three groups of any group of B groups and 15 healthy controls were compared to A group, and the quantitative analysis index of heart rate variability was obtained by dynamic electrocardiogram monitoring. DANN, pNN50 also measured the first second forced expiratory volume (forced expiratory volume in one second, FEV1) using the pulmonary function instrument (Ms-PFT; Jaeger:Analyzer, Unit). The scores of asthmatic patients' daytime, nocturnal asthma symptoms and daily use of short acting beta 2- agonists were obtained.
(2) C, D two groups of asthmatic patients also used the above (1) methods to determine the quantitative index of heart rate variability (LF.HF.SDANN.pNN50); pulmonary function FEV1, FEV1%: day, night asthma symptom score and the number of short acting p2- receptor agonists.
(3) B, C, D three groups of asthmatic patients (group B as ICS+LAMA:C group ICS+LABA:D group ICS+LAMA+LABA) after 6 weeks of treatment in accordance with the treatment program, again using dynamic electrocardiogram monitoring to get the quantitative analysis index of heart rate variability after treatment, and use lung function meter lung function measuring instrument to determine the FEV1, FEV1%, root after the treatment. According to the asthma symptom score, the number of asthmatic patients during daytime, nocturnal asthma symptoms and the daily use of short acting beta 2- agonists were obtained.
(4) ICS - fluticasone fluticasone aerosol (commodity name: coferone, GlaxoSmithKline Co production, specification: 125 micrograms) 2 times a day, 2 times every morning and evening; ICS+LABA - salmeterol carpasone dry powder (commodity name: suletide, GlaxoSmithKline Co production, 50/250 microgram) 2 times a day, every morning and night, each inhalation: LAMA - Thito Ammonium bromide powder inhalation (Zhejiang immortal pharmaceutical company production, specifications: 18 micrograms) inhalation, once a day; Salbutamol Aerosol (commodity name: Wan Tuo Lin, GlaxoSmithKline Co production, specification: 100 micrograms) on demand.
Result
1, the patients with bronchial asthma compared with the healthy control group, that is, group B and A, reflecting the HF and pNN50 of the parasympathetic nerve, reflecting the LF and SDANN of sympathetic nerve, and the difference between the normal control group and the normal control group (P0.05).2, B, C, D three groups of asthmatic patients after 6 weeks of drug treatment. N increased, the difference was not statistically significant, C group HF, pNN50 decreased, LF, SDANN increased, but there was no statistical significance compared with before drug use; D group HF, pNN50 decreased, LF, SDANNB increased, the difference was statistically significant before medication. Three groups of day, night symptom scores were lower than before use of short acting p2- receptor agonists. The decrease of FEV1 and FEV1% in lung function were better than before treatment. The difference between the three groups was statistically significant.
3, B, C, D three groups of asthma patients after 6 weeks of drug treatment, compared with the quantitative analysis index of heart rate variability (HF, pNN50, LF, SDANN), B group and C group, C group and D group have statistical significance, B group and the group difference is not statistically significant. The difference between group D and group C was statistically significant. The times of day, night symptom score and the use of short effect p2- receptor agonists showed no significant difference between group B and group C. There was a significant difference between group B and group D, and that of group C and D group.
conclusion
(1) patients with moderate persistent bronchial asthma in non acute episodes have autonomic nervous dysfunction, showing an increase in HF, PNN50, which reflects the excitability of the parasympathetic nerve, which reflects the LF of sympathetic excitability, and a decrease in SDANN.
(2) the long-acting anticholinergic drug Tiotropium Bromide Powder for Inhalation combined with glucocorticoid can reduce HF, PNN50, and reduce the excitability of parasympathetic nerve; in improving autonomic nervous dysfunction, anticholinergic drugs combined with glucocorticoid group are superior to the long effect beta 2- receptor agonist combined with glucocorticoid group; in alleviating asthma symptoms. The effect of the two groups on improving lung function is quite effective. The combined use of the above three drugs has a better clinical effect in improving lung function, reducing heart rate variability, reducing asthma symptom score and using short effect beta 2- receptor agonist.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R562.25

【参考文献】