本文選題：進食 + 自主神經��； 參考：《南方醫(yī)科大學》2014年碩士論文

【摘要】：目的和意義： 當前社會競爭激烈,亞健康狀態(tài)日益增多。其中,胃腸功能紊亂被認為是亞健康的主要表現(xiàn)之一。胃腸功能紊亂是指臨床檢查未發(fā)現(xiàn)器質性改變,但機體出現(xiàn)飽脹、餐后不適、惡心嘔吐、上腹痛、燒心感、便秘等臨床表現(xiàn)的一種疾病。據(jù)文獻報道,全球人群中有10%-20%的胃腸功能紊亂癥狀,女性多于男性。我國廣東等地曾開展關于胃腸功能紊亂流行病學調查研究顯示廣州市2001年、廣東省2004年的患病率分別為5.6%和5.62%[2]。同時陳e萚3]在對廣東城鎮(zhèn)居民進行問卷調查也顯示功能性消化不良患病率為18.92%。現(xiàn)代醫(yī)學認為,自主神經功能異常和胃腸功能紊亂關系密切[7]。但胃腸功能紊亂者自主神經的活動有何特點,其進食前后的變化有何異常,目前還沒有確切的結果。原因之一是由于機體在正常狀況下進食前后的自主神經活動還需進一步闡明。 1.心率變異性是目前反映自主神經活動的最為敏感且無創(chuàng)性的量化指標 很早人們就認識到自主神經對胃腸道調節(jié)和食物代謝起到重要的作用,如進食前后胃腸道蠕動的變化,食物的動力學效應,都與自主神經(即交感和副交感神經)的調節(jié)有關,但進食前后,交感和副交感神經是如何變化的,是直到心率變異性的應用,才有了較為客觀具體的研究。 目前對人體自主神經功能的檢測方法主要有體位性血壓測試、皮膚交感反應、深呼吸心率變異、瓦氏動作反應指數(shù)等,但上述這些方法僅能單獨反映交感神經或副交感神經的功能,靈敏度和特異度均較差[8]。而且在測試的過程中需要被試高度配合,故不益于廣泛使用。心率變異性(Heart Rate Variability,HRV)被公認為是目前反映自主神經活動的最為敏感且無創(chuàng)性的量化指標。心率變異性是通過心搏間的微小差異來反映自主神經對心臟竇房結的調控。其中,頻域分析法可將復雜的心率波動信號按不同頻段來描述能量的分布情況,能對交感神經和副交感神經的活動水平進行量化。頻域分析可獲得多項指標,按頻段對應的生理意義可分為以下幾種：低頻段(LF),頻率在0.04-0.15Hz之間,能量主要來自包括動脈壓的短期調整在內的相關機制,反映交感神經調制強度；高頻段(HF),頻率在0.15-0.4Hz之間,能量主要來自呼吸運動對心臟間期信號的影響,反映副交感神經調制強度；交感/副交感平衡比(LF/HF),是交感神經活性和副交感神經活性的比值,反映交感神經與副交感神經對心臟進行雙重調節(jié)的平衡性。 2.餐前餐后自主神經功能波動變化研究爭議 目前,已有研究采用HRV頻譜分析的方法評價成年人餐前餐后的自主神經功能狀態(tài),但研究結果存在爭議。Vaz M[32]等人認為HF值在進餐后有下降的趨勢,即進餐后迷走神經活動減弱；Kaneko[38]等人則認為HF在餐后的5min內有細微的顯著性升高。同時Lipsitz[39]等人在健康青年志愿者的餐后記錄中發(fā)現(xiàn)伴隨著心臟交感神經活動的增強心率變異性指標LF值有明顯的升高。這些結果 不一致,直接影響到我們對正常情況下自主神經對胃腸道調節(jié)的規(guī)律的認識,也妨礙了我們進一步了解胃腸功能紊亂的自主神經活動狀態(tài),通過調節(jié)自主神經來對胃腸功能紊亂進行調節(jié)。 3.導致餐前餐后自主神經功能波動變化研究爭議的原因分析 已有的研究存在的爭議可能由以下因素導致：1.目前的研究只對餐前和餐后的數(shù)據(jù)進行了比較分析,沒有設立嚴格的對照；2.HRV呈現(xiàn)波動性,即使在同樣的清醒或者睡眠狀態(tài)下HRV指標值均會有顯著地波動變化；3.實驗過程中,志愿者不自覺地進入睡眠狀態(tài)會對研究結果有干擾。 4.本研究的目的和意義 因此,本研究擬在前人研究的基礎之上,進一步探索正常人進食前后自主神經功能的變化。采用流行病學自身前后對照的實驗設計,應用HRV頻域指標動態(tài)平移的方法,比較進食對清醒狀況下正常人自主神經活動的影響。旨在揭示由于進食對自主神經活動的影響,從而為進一步研究亞健康狀態(tài)下胃腸功能紊亂的自主神經活動及對其自主神經功能進行有效調節(jié)提供理論依據(jù)。 方法： 1.樣本人群的納入標準在年齡在20-30歲的在校大學生中,選擇健康無器質性疾病病史且2年內無明顯胃腸功能紊亂表現(xiàn)的大學生作為被試。有以下胃腸功能紊亂表現(xiàn)的人群需要排除：臨床表現(xiàn)主要在胃腸道,涉及進食和排泄等方面的不正常,也常伴有失眠、焦慮、注意力不集中、健忘、神經過敏、頭痛等其他功能性癥狀[62-63]。最終選取其中22例健康大學生進行實驗。 2.實驗方案 本研究采用自身前后對照研究：每人進行三次進食實驗,分別計入HC(高熱量試驗組)、LC(低熱量試驗組)和對照組。其中,高熱量組給予470kca1(碳水化合物270kcal,脂肪104kcal,蛋白質54kcal,其他20kcal)熱量的食物,低熱量組給予160kcal(碳水化合物50kcal,脂肪90kcal,蛋白質30kcal,其余10kcal)熱量的食物,對照組不給予食物。所有志愿者均要求在測試前禁食8小時或以上,試驗在清晨7：30---9：30之間進行。 3.檢測指標：心電檢測；腦電檢測 使用美國Bio-logic公司生產的PSG多導睡眠儀分別監(jiān)測給予實驗處理前后的腦電圖(EEG)和心電圖(ECG)。根據(jù)志愿者的EEG記錄,截取實驗處理前后同為清醒狀態(tài)下的心電數(shù)據(jù)進行比較。使用MATLAB R2007a軟件對獲得的心電數(shù)據(jù)進行分析,將之轉化為一系列有序的RR間期(RRI)。用Kubios HRV version2.0軟件對RRI數(shù)據(jù)作進一步處理,獲得研究所需的HRV指標。 4.分析指標 睡眠分期:NREM睡眠(即非快動眼睡眠sleep stage1,2,3,4)以及REM睡眠(快動眼睡眠)；HRV分析(LF、HF、LFnu、HFnu、LF/HF)。 5.統(tǒng)計方法 實驗數(shù)據(jù)通過SPSS20.0軟件進行統(tǒng)計分析。LF、HF、LFnu、HFnu、LF/HF等計量資料的描述采用均數(shù)±標準差(x±s)；進食對自主神經活動的影響采用配對樣本t檢驗進行比較(Paired-Samples t-test)。檢驗水準α設為0.05。 結果： 1.基線情況 這22例健康自愿者中男性10例、女性12例。男女性別年齡均可比(t=0.823,p0.05)、BMI (t=0.946,p0.05)。本研究中,標準多導睡眠圖以及心電圖連續(xù)記錄30min。實驗期間所有實驗對象至多進入到睡眠1-2期,大部分實驗對象(19/22,86.3%)在平躺的狀態(tài)下無意識進入睡眠狀態(tài)。 2.睡眠狀態(tài)對研究結果存在一定的干擾 在本研究中,標準多導睡眠圖以及心電圖連續(xù)記錄30min,這個時間段一般實驗對象至多能進入到睡眠1-2期。大部分實驗對象(19/22,86.3%)在平躺的狀態(tài)下無意識進入睡眠狀態(tài)。由于睡眠一期的長度比較短,我們將禁食狀態(tài)下實驗對象1期跟清醒狀態(tài)下的LF,HF以及LF/HF數(shù)據(jù)的值組合在一起與睡眠 2期狀態(tài)下各指標的值進行比較。在清醒狀態(tài)與睡眠2期狀態(tài)下各指標的比較中,除了LF/HF其余各指標均有顯著性差異(P0.05)。相比較睡眠2期狀態(tài),HR和LFnu值在清醒階段明顯較高；然而LF, HFnu值則在清醒階段相對較低。這些結果表明在分析進食對于自主神經活動影響的時候,應考慮到實驗對象自主神經的變化會隨著睡眠狀態(tài)的變化而變化。因此,本研究均選用清醒狀態(tài),對進食前后的自主神經活動進行比較。 3.HRV指標在相同睡眠狀態(tài)下存在波動 本研究對22例實驗對象均采取按順序以5min為窗口地連續(xù)記錄進行HRV頻譜分析。結果觀測到LF,HF and LF/HF指標值的波動。隨機選取其中一人的數(shù)據(jù)為例,在圖表3-1中發(fā)現(xiàn)在相同睡眠狀態(tài)下LF,HF and LF/HF指標值均存在連續(xù)性地波動。 4.同熱量的進食對自主神經波動的影響 4.1對HRV指標均值的影響 本實驗中,分別對各組處理前后的指標進行配對t檢驗(Paired-sample t test)比較,,研究不進食、進食低熱量及進食高熱量是否會對HRV指標造成不一樣的影響。結果顯示：(1)對照組、低熱量組中處理前后各指標的變異系數(shù)無明顯差異。,(2)高熱量組餐后的HR, LFnu以及LF/HF相較于餐前均有顯著升高(P0.05),其余指標在三組間的比較均無顯著差異。 4.2對HRV指標變異系數(shù)CV的影響 通過對對照組、低熱量試驗組以及高熱量試驗組的心率與HRV指標的變異系數(shù)進行分析,分析結果顯示：(1)對照組、低熱量組中處理前后各指標的變異系數(shù)無明顯差異。(2)高熱量組餐后HR, LF, HF, HFnu及LF/HF的變異系數(shù)較餐前均顯著升高(P0.05),其余指標無顯著差異。4.3進食對自主神經功能的影響在性別間的差異 對同為空腹狀態(tài)下的HRV指標進行性別間的比較,結果顯示,除男性志愿者的平均心率低于女性志愿者外(P0.05),其余指標LF、HF、LFnu、HFnu、 LF/HF等在男女間的差異沒有統(tǒng)計學意義。(1)對男性志愿者中對照組、低熱量組以及高熱量組HRV指標均數(shù)的進行分析,結果顯示,高熱量組餐后的HR以及LF較餐前有顯著性升高(P0.05),其余指標在三組間的比較無顯著差異。(2)對女性志愿者中對照組、低熱量組以及高熱量組HRV指標均數(shù)進行分析,結果顯示,高熱量組餐后的HR以及LF/HF較餐前都有顯著性升高(P0.05),其余指標在三組間的比較無顯著差異。 結論： 1.采用流行病學自身前后對照的實驗設計,相對于單純地比較餐前和餐后HRV指標數(shù)據(jù)的差異,能更客觀、準確和直接地表現(xiàn)由于進食所導致的HRV指標的波動變化。 2.志愿者在測試過程中很容易進入到非快動眼睡眠階段,而睡眠狀態(tài)對自主神經也會有一定的影響,因此,在分析進食對于HRV波動變化的影響時,要考慮睡眠狀態(tài)的混雜。 3.在進食過程中,進食熱量的不同會造成HRV指標值出現(xiàn)差異。攝入較低熱量的食物并不會對HRV其他指標造成影響;攝入高熱量(450kca1)的食物會造成餐后HR和LF/HF顯著地升高。 4.在進食過程中,進食熱量的不同會造成HRV指標的變異系數(shù)出現(xiàn)差異。研究結果顯示高熱量組餐后HF值的變異系數(shù)顯著增大,說明高熱量組HF的波動性較低熱量組及對照組大,可以認定HF的這種變化極有可能也是受進食所導致。 5.進食對心率變異性的影響存在性別間的差異,女性的心率變異性受進食的影響較男性顯著。
[Abstract]:Purpose and significance:
The current social competition is fierce and subhealth is increasing. Among them, gastrointestinal dysfunction is considered as one of the main manifestations of subhealth. Gastrointestinal dysfunction refers to a disease that has not found organic changes in clinical examination, but the body appears to be full, postprandial discomfort, nausea and vomiting, upper abdominal pain, heartburn, constipation and other clinical manifestations. In the global population, there were 10%-20% symptoms of gastrointestinal dysfunction and more women than men. The epidemiological investigation of gastrointestinal dysfunction in Guangdong and other places in China showed that in 2001 in Guangzhou, the prevalence rate in 2004 in Guangdong province was 5.6% and 5.62%[2]., respectively, and E? 3], in Guangdong urban residents, also showed the merit of the questionnaire. The prevalence of dyspepsia is 18.92%. modern medicine. It is considered that the dysfunction of autonomic nervous function and gastrointestinal dysfunction is closely related to [7]., but what is the characteristic of the autonomic nervous activity in the patients with gastrointestinal dysfunction, what is the abnormal changes before and after eating, and there is no definite result at present. One of the reasons is that the body is in normal condition before eating. The subsequent autonomic nerve activity needs to be further clarified.
1. heart rate variability is currently the most sensitive and noninvasive quantitative indicator of autonomic nervous activity.
Early people recognized that the autonomic nerve plays an important role in the gastrointestinal regulation and food metabolism, such as the changes in the gastrointestinal peristalsis before and after eating, the dynamic effects of food, and the regulation of the autonomic nerve (sympathic and parasympathetic nerve), but how the sympathetic and parasympathetic nerves change before and after eating, which is until the heart rate variation. There is a more objective and specific research on the application of sex.
At present, the methods of detecting autonomic nervous function mainly include body position blood pressure test, skin sympathetic response, deep breathing heart rate variation, and valson action response index, but these methods can only reflect the function of sympathetic or parasympathetic nervous system alone, the sensitivity and specificity are poor [8]. and need to be used in the process of testing. Heart Rate Variability (HRV) is recognized as the most sensitive and noninvasive quantitative indicator of autonomic nervous activity. Heart rate variability reflects the regulation of autonomic nerve to the sinoatrial node through a small difference between the heart beat. Complex heart rate fluctuation signals describe the distribution of energy according to different frequency bands and quantize the activity level of sympathetic and parasympathetic nerves. Frequency domain analysis can obtain a number of indicators. The physiological significance of the frequency domain can be divided into the following categories: low frequency (LF), frequency between 0.04-0.15Hz, energy mainly from arterial pressure The relative mechanism of short-term adjustment reflects the modulation intensity of sympathetic nerve; high frequency (HF), frequency between 0.15-0.4Hz, energy mainly comes from the influence of respiratory movement on interphase signals, reflecting the modulation intensity of parasympathetic nerve; sympathetic / parasympathetic balance ratio (LF/HF), the ratio of sympathetic and parasympathetic activity, and the ratio of sympathetic and parasympathetic nerve activity. The balance between sympathetic and parasympathetic nerves regulate the heart.
2. postprandial postprandial autonomic nervous function fluctuations
At present, the HRV spectrum analysis has been used to evaluate the autonomic nervous function status of adult postprandial postprandial neural function, but the results are controversial.Vaz M[32] and others believe that the HF value decreases after the meal, that is, the vagus nerve activity is weakened after the meal, and Kaneko[38] and others believe that HF has a slight significant rise in the 5min after the meal. Lipsitz[39] et al. Also found a significant increase in the LF value of the heart rate variability index associated with cardiac sympathetic activity in the postprandial records of healthy young volunteers.
The inconsistency directly affects our understanding of the regularities of the gastrointestinal regulation of the autonomic autonomic nerve under normal conditions, and also hinders us to further understand the autonomic nervous activity state of the gastrointestinal dysfunction, and regulates the gastrointestinal dysfunction by regulating the autonomic nerve.
3. causes of controversy on autonomic nervous function changes after prandial meal
The existing disputes may be caused by the following factors: 1. the current study is only a comparative analysis of pre - and post - meal data, without a strict control; 2.HRV is fluctuating, even in the same sober or sleep state, with significant fluctuations in the value of the HRV index; 3. in the course of the experiment, volunteers Unconscious sleep can interfere with research results.
4. purpose and significance of the study
Therefore, on the basis of previous studies, this study intends to further explore the changes in autonomic nervous function of normal people before and after eating. By using the experimental design before and after epidemiology, the effect of feeding on the autonomic nervous activity of normal people in sober condition is compared with the method of HRV frequency domain index dynamic translation. The effect of food on autonomic nervous activity provides a theoretical basis for further study of autonomic activity of gastrointestinal dysfunction and the effective regulation of autonomic nervous function in subhealth state.
Method錛，

本文編號：1897805