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常丽丽, 周晓娜, 张淑梅, 刘润, 石家庄市第一医院消化内科 河北省石家庄市 050011
姚树坤, 卫生部中日友好医院 北京市 100029
任锡玲, 河北医科大学第二医院消化内科 河北省石家庄市 050051
高富贵, 河北省卫生厅卫生监督局 河北省石家庄市 050071
河北省科学技术厅2006河北省科学技术研究与发展指导计划资助项目, No. 062761896.
通讯作者: 高富贵, 050071, 河北省石家庄市, 河北省卫生厅卫生监督局. guifugao@163.com
收稿日期: 2007-06-14 修回日期: 2007-09-17
Characteristics of
autonomic nervous activity before and after meals in subjects with
obesity
Li-Li Chang, Shu-Kun Yao, Xi-Ling Ren, Fu-Gui Gao, Xiao-Na Zhou,
Shu-Mei Zhang, Run Liu
Li-Li Chang, Xiao-Na Zhou, Shu-Mei Zhang, Run Liu, Department of
Gastroenterology, the First Hospital of Shijiazhuang City, Shijiazhuang
050011, Hebei Province, China
Shu-Kun Yao, Hygiene Administration China-Japan Friendship
Hospital, Beijing 100029, China
Xi-Ling Ren, Department of Gastroenterology, the Second Hospital
of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
Fu-Gui Gao, Hebei Province Hygiene Hall Sanitary Supervision
Bureau, Shijiazhuang 050071, Hebei Province, China
Supported by: Hebei Province Science and Technology Hall 2006
Development and Guide Plan, No. 062761896
Correspondence to: Fu-Gui Gao, Hebei Province Hygiene Hall
Sanitary Supervision Bureau, Shijiazhuang 050071, Hebei Province, China.
guifugao@163.com
Received: 2007-06-14 Revised: 2007-09-17
Abstract
AIM: To observe the characteristics of autonomic nervous activity
before and after meals in individuals with obesity, and to discuss the
relationship between autonomic nervous activity and gastric motility .
METHODS: One hundred and two subjects with obesity and 49
controls were studied with 24-hours dynamic electrocardiography, and the
electrocardiograms were recorded 1 hour before and after meals. Heart
rate variability was analyzed.
RESULTS: Before a meal, SDNN index, RMSSD, high frequency power (HF)
and ultra-low frequency power (ULF) in subjects with obesity were higher
than those in control subjects (87.31 ± 15.64 ms, 82.50 ± 67.19 ms,
31 168.60 ± 6361.00 ms2, 22 814.17 ± 4083.90 ms2 vs 79.38 ± 12.28
ms, 56.04 ± 10.15 ms, 12 999.4 ± 5995.00 ms2, 16 595.75 ± 5615.09 ms2,
P < 0.05, P < 0.01), and L/H was lower in subjects with
obesity than in the controls (0.65 ± 0.43 vs 0.99 ± 0.42, P
< 0.01). After a meal, RMSSD and HF were higher in subjects with obesity
than in the controls (87.90 ± 57.21 ms, 36 158.56 ± 6361.00 ms2 vs
39.25 ± 11.15 ms, 6570.50 ± 5995.80 ms2, P < 0.01). SDNNindex,
ULF and low-frequency power (LF)/HF were lower in the subjects with
obesity than in the controls (79.59 ± 32.54 ms, 14 135.7 ± 8083.90 ms2,
0.63 ± 0.34 vs 141.67 ± 10.28 ms, 22 785.63 ± 9615.20 ms2, 1.11 ±
0.32, P < 0.01). Compared with before meals, SDNNindex, ULF and
LF/HF after meals increased significantly in the controls (P <
0.01), and RMSSD and HF decreased markedly (P < 0.01). In
subjects with obesity, after meals, SDNNindex and ULF decreased, and
RMSSD and HF increased significantly (P < 0.01); LF/HF did not
differ between before and after meals (P > 0.05).
CONCLUSION: In fasting and post-prandial states, people with
obesity have abnormal autonomic nervous activity. This may be one
mechanism of hypermotility in obesity.
Key Words: Obesity; Autonomic nervous activity; Heart rate
variability; Electrocardiography
Chang LL, Yao SK, Ren XL, Gao FG, Zhou XN, Zhang SM, Liu R.
Characteristics of autonomic nervous activity before and after meals in
subjects with obesity. Shijie Huaren Xiaohua Zazhi 2007; 15(27):
2955-2957
摘要
目的: 观察单纯性肥胖者进餐前后自主神经活动特征, 探讨其与肥胖者胃动力异常的关系.
方法: 采用十二导联动态心电记录仪, 记录102例单纯性肥胖者和49例正常体重健康志愿者, 餐前和餐后1 h心电信号,
进行心率变异分析.
结果:
餐前肥胖组RR间期标准差的平均值(SDNNindex)和RR间期差值的均方根(RMSSD)、高频功率(HF)、超低频功率(ULF)显著高于对照组(87.31±15.64
ms, 82.50±67.19 ms, 31 168.60±6361.00 ms2, 22 814.17±4083.90 ms2 vs
79.38±12.28 ms, 56.04±10.15 ms, 12 999.4±5995.00 ms2, 16 595.75±5615.09
ms2, P<0.05, P<0.01), L/H显著低于对照组(0.65±0.43 vs
0.99±0.42, P<0.01); 餐后肥胖组RMSSD, HF显著高于对照组(87.90±57.21 ms,
36 158.56±6361.00 ms2 vs 39.25±11.15 ms, 6570.50±5995.80 ms2,
P<0.01), SDNNindex, ULF, LF/HF显著低于对照组(79.59±32.54 ms,
14135.7±8083.90 ms2, 0.63±0.34 vs 141.67±10.28 ms,
22 785.63±9615.20 ms2, 1.11±0.32, P<0.01); 对照组餐后SDNNindex,
ULF较餐前升高, RMSSD, HF较餐前降低, LF/HF餐后较餐前升高; 肥胖组SDNNindex, ULF较餐前降低, RMSSD,
HF较餐前升高; LF/HF餐后和餐前无差异(P>0.05).
结论: 单纯性肥胖者餐前餐后均存在自主神经活动异常, 自主神经活动异常可能是导致肥胖者胃动力亢进的主要原因之一.
关键词: 单纯性肥胖; 自主神经; 心率变异; 心电记录仪
常丽丽, 姚树坤, 任锡玲, 高富贵, 周晓娜, 张淑梅, 刘润. 单纯性肥胖者进餐前后自主神经功能的变化特征. 世界华人消化杂志
2007;15(27):2955-2957
http://www.wjgnet.com/1009-3079/15/2955.asp
0 引言
目前全球超过10亿的成人和10%的儿童属于超重和肥胖. 每年与肥胖相关的死亡人数在11.2-28万之间.
肥胖问题已成为亟需解决的严重影响人类健康的重大医学问题和社会问题. 肥胖与胃排空过速或胃动力亢进有关[1-2].
而胃运动受自主神经调控, 且自主神经对食物摄入、产热、能量消耗有双向调节作用. 本研究观察了单纯性肥胖者进餐前后1 h自主神经活动变化特征,
探讨了其与肥胖者胃动力的关系.
1 材料和方法
1.1 材料 单纯性肥胖者(体质量指数BMI≥30 kg/m2)102例, 男53例, 女49例, 平均年龄(27.8±8.4)岁,
BMI为(32.2±1.6) kg/m2为肥胖组. 正常体质量(BMI 18-24.9 kg/m2)健康志愿者49例为对照组, 男25例,
女24例, 平均年龄(25.6±8.2)岁, BMI为(22.3±2.6) kg/m2. 所有受试对象年龄≥18岁, 没有胃肠道疾病史,
没有消化道手术史, 无高血压及冠心病, 哮喘、呼吸暂停综合征, 无吸烟及饮酒史. 受试者未曾应用任何药物.
排除(1)继发于神经-内分泌-代谢紊乱基础上的多种疾病中伴肥胖症: 下丘脑病; 垂体病; 胰岛疾病; 甲状腺功能减退症; 肾上腺皮质功能亢进症;
性腺功能低下症; 其他: 水钠贮留性肥胖症等, 除外糖尿病胃轻瘫, 除外功能性消化不良. (2)女性受试者在妊娠期、哺乳期.
1.2 方法 禁食12 h, 采用美国PI(Preideal Instruments)公司生产的十二导联动态心电记录仪,
记录受试者餐前静息状态心电信号1 h, 进餐(康师傅方便面127 g: 碳水化合物88 g, 脂肪25 g, 蛋白质14 g, 总热量633
kcal)后静卧, 再记录心电信号1 h, 观察下列指标: (1)时域指标: 每5 min正常R-R间期的标准差(SDNN,
单位ms)、平均值(SDNNindex, 单位ms)、差值的均方根(RMSSD, 单位ms). (2)频域指标: 高频功率(HF,
单位ms2)、超低频功率(ULF, 单位ms2)、低频功率(LF, 单位ms2)、低频功率/高频功率比值(LF/HF).
统计学处理 计量资料数据以mean±SD表示, 采用STATA 8.0软件,
两个样本均数间比较采用t检验, 方差不齐采用t'检验.
2 结果
2.1 餐前和餐后心率变异参数比较 餐前肥胖组SDNN, SDNNindex, RMSSD, ULF, LF, HF显著高于对照组, LF/HF肥胖组显著低于对照组;
餐后肥胖组SDNN, RMSSD, LF, HF显著高于对照组, SDNN index, ULF显著低于对照组, LF/HF肥胖组显著低于对照组(表1).
表1 肥胖组与对照组餐前餐后HRV参数比较(mean±SD)
2.2 餐后与餐前HRV参数变化规律 正常体质量组SDNNindex, ULF餐后较餐前显著增高, SDNN, RMSSD, LF, HF餐后较餐前显著降低,
LF/HF餐后较餐前显著增高; 肥胖组SDNN, SDNNindex, ULF餐后较餐前显著降低, RMSSD, LF, HF餐后较餐前显著增高,
餐后与餐前LF/HF无显著差异, P>0.05.
3 讨论
WHO公布BMI≥30 kg/m2即为肥胖[3], 胃动力亢进或胃排空加快在肥胖形成中可能起重要作用.
胃肠动力受自主神经影响. 交感神经兴奋抑制胃肠蠕动, 迷走神经兴奋促进胃肠蠕动. 心率变异系统能够反映患者的自主神经活动情况[4-7].
SDNNindex, ULF反映交感神经活性, RMSSD, HF反映迷走神经活性, SDNN, LF反映迷走和交感的综合效应;
L/H反映迷走和交感神经的平衡功能. 国内外有关肥胖者自主神经功能活动与胃动力相关性的研究极少, 有文献报道肥胖者与非肥胖者相比,
存在交感神经活性减弱[8-10], 迷走神经活性增强[11].
也有相反报道肥胖者存在交感神经活性增强, 迷走神经活性减弱[12-17]. 考虑这些矛盾报道与肥胖者病例入选标准不一有关,
如肥胖者是否为青少年或儿童; 处于肥胖发展期还是静止期, 是否伴有功能性消化不良,
是否伴发高血压、糖尿病、心脑血管疾病、呼吸暂停综合征以及是否有饮酒或吸烟嗜好等[5,7].
本研究入选标准剔除上述人群, 结果发现餐前1 h肥胖组SDNN, SDNNindex, RMSSD, ULF, LF,
HF显著高于对照组, LF/HF肥胖组显著低于对照组, 说明空腹状态肥胖组迷走神经功能和交感神经功能均较正常体质量者活跃,
但以迷走神经功能变化更明显. 餐后1 h肥胖组SDNN, RMSSD, LF, HF显著高于对照组, SDNNindex, ULF, LF/HF肥胖组显著低于对照组,
说明餐后肥胖组迷走神经功能较正常体质量者亢进, 交感神经功能减弱, 导致肥胖者进食量增大, 胃排空加快, 胃动力亢进, 产热减少,
能量消耗减少, 脂肪堆积.
正常体质量者SDNNindex, ULF餐后较餐前显著增高, RMSSD, LF, HF餐后较餐前显著降低, LF/HF餐后较餐前增高,
P<0.01; 肥胖组SDNNindex, ULF餐后较餐前显著降低, RMSSD, LF, HF餐后较餐前增高,
餐后与餐前LF/HF无显著差异, P>0.05. 进餐后, 正常体质量者交感神经活性增加, 迷走神经活性降低;
而肥胖者这种节律发生紊乱, 交感神经活性降低, 迷走神经活性增强, 提示自主神经功能紊乱可能是导致肥胖者食欲增强, 胃动力亢进的重要因素.
肥胖形成非单一因素所致, 自主神经功能异常可能仅是肥胖形成的其中一个环节, 亦有可能是肥胖导致交感和迷走神经活动异常.
二者的确切关系有待进一步研究探讨.
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电编 马文华 编辑 程剑侠
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