心跳變異生理回饋在冠心病患者的生理病理機制之驗證

目的：冠狀動脈心臟病(coronary artery disease, CAD)之生理病理機制為心臟自主神經(cardiac autonomic)失調或/與下視丘-腦下垂體-腎上腺軸(hypothalamus-pituitary-adrenal axis)失調，引起較高的心血管反應與內皮細胞失功能，長期下來可能導致動脈硬化歷程及發炎反應。研究已證實心跳變異生理回饋(heart rate variability biofeedback, HRV-BF)可提升CAD患者之整體心跳變異，並有效調節情緒，但尚未有研究證實HRV-BF可改善或減緩發炎反應與動脈硬化程度。本研究目的驗證HRV-BF介入對CAD生理病理機制(ANS反應、發炎反應、動脈硬化程度)之療效。研究方法：154名之穩定的CAD患者隨機分派為治療組(6女/71男，平均61.01 ± 8.41歲)和常規醫療組(11女/66男，平均60.61 ± 8.03歲)，治療組接受連續六周的HRV-BF。兩組均接受前測及後測的自主神經反應[心跳變異率(heart rate variability, HRV)]、發炎反應[高敏感C反應蛋白(high sensitive C reactive protein, hsCRP)]以及動脈硬化程度之測量，以驗證HRV-BF之療效。研究結果：二因子變異數分析發現，治療組相較於常規醫療組在後測的HRV (SDNN/ LF/lnLF)指標顯著高於前測，具有組別 * 時間的交互作用(分別為F(1,67) = 5.70, p < .05, ηp2 = .08 ; F(1,67) = 14.76, p < .001, ηp2 = .18 ; F(1,67) = 12.90, p < .01, ηp2 = .16)。發炎反應方面，雖治療組的hsCRP有下降，常規醫療組上升，但組別 * 時間的交互作用不顯著。動脈硬化指標方面，單純主要效果檢定發現，治療組在後測的動脈硬化程度顯著低於前測(F(1,77) = 7.14，p<.05)，但常規醫療組的前測和後測之動脈硬化程度則無顯著差異(F(1,77) = 0.62，p>.05)。結論：本研究支持HRV-BF有助於改善CAD患者之自主神經反應與動脈硬化程度。

關鍵字

冠心病；心臟自主神經；動脈硬化；發炎反應；心跳變異生理回饋

並列摘要

Objective: The pathophysiological mechanisms of coronary heart disease (CAD) are cardiac autonomic imbalance or / and hypothalamus-pituitary-adrenal axis dysregulation, causing higher cardiovascular responses and endothelial dysfunction, eventually may lead to atherosclerosis and inflammation course. Previous studies have confirmed heart rate variability biofeedback (HRV-BF) can increase heart rate variability and regulate emotion among patients with CAD. However, HRV-BF in reducing the degree of inflammation response and atherosclerosis are still unknown. This study was to examine the efficacy of HRV-BF in pathophysiological mechanisms among patients with CAD (e.g., cardiac autonomic, inflammation response, and arterial stiffness). Methods: A total of 154 stable CAD were assigned randomly to HRV-BF group (6 female / 71 male, mean age was 61.01 ± 8.41 years) and control group (11 female / 66 male, mean age was 60.61 ± 8.03 years), the HRV-BF group received six consecutive weeks of HRV-BF. Both groups received the measurement of cardiac autonomic response (heart rate variability, HRV) , inflammation response (high sensitive C reactive protein, hsCRP) and arterial stiffness at the pre-test and at the post-test. Results: Two-way ANOVA found that there were significant group * time interaction (F (1,67 ) = 5.70, p <.05, ηp2 = .08; F (1,67) = 14.76, p <.001, ηp2 = .18; F (1,67) = 12.90, p <.01, ηp2 =. 16) in HRV indices (SDNN/ LF/ lnLF), the post hoc comparison found that higher HRV indices in the treatment group than that in the control group at post-test. There were slight decreased in inflammatory response (hsCRP) in the treatment group and increased in the control group, however, there was no interaction effect in hsCRP. Regarding the arterial stiffness, simple main effects found that there was significant lower baPWV at post-test than that at pre-test in treatment group (F (1,77) = 7.14, p < 0.05). However, this situation did not found in the control group (F (1,77) = 0.62, p > 0.05). Conclusion: This study supports HRV-BF can improve the cardiac autonomic activation and decrease arterial stiffness among patients with CAD.