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SİROZLU HASTALARDA OTONOMİK DİSFONKSİYON: BİR KALP HIZI DEĞİŞKENLİĞİ ÇALIŞMASI

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 1999

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Autonomic nervous system (ANS) dysfunction is observed in ehronic hepatic disease (CHD). The purpose of this study is to correlate the severity of liver dysfunction wifh ANS dysfunction as assessed by heart rate variability (HRV). The study group was consisted of 15 non-aleholic cirrhosis (13 ma-le, 2 female, mean age 48±8 years) and 15 age and sex matehed heaifhy controls (13 male, 2 female mean age 47+10 years ). The frequency of Child A,B and C were 5 (33%) and 4 (27%) respeetively. On M Mode echocardiography left atrial dimensions (4.13±0.53 cm vs. 3.4+0.5 cm, p-0.006) and interventricular septum thickness (1.09±0.18cm vs 0.92+0.17 cm,p=0.04) were signifi-cantly İncreased in cİrrhotic patients On frequency-domain and time-domain analysis al para-meters were significantly lowcr in the cirrhotİc patients compared to controls; pNN50 (The percentage of the beats with consecutive RR interval difference of morc than 50 müliseconds): 1.46+3.1 vs 8.45+6.1, p=0.0001, total power (TP) (The urea under the spectral curve from 0.01 to 1.0 Hz): 15.5+6.0 vs 39.6+7.7, p<0.0001, low-frequency power (LF) (The area under the spectral curve from 0.04 to 0.15 Hz): 9.9±4.6 vs 26.8±4.9, p<0.0001, high-frequency po¬wer (HF) (The area under the spectral curve from 0.15 to 0.40 Hz): 5.5±2.0 vs 12.7+4.8, p-0.0001, SD (The mean of the 5-minute RR intervai standart deviations): 27.3+8.5 vs 58.8+12.4, p<0.0001, SDNN (The standart deviation of ali the RR intervals): 73.1+23.2 vs 152+27.7, p<0.0001, rMSSD (The square root of the mean of the squared differences of two consecutive RR intervals): 15.5±7.0 vs 30.9±10.0, p-0.0001).Child-Pugh score; dthe indicator of the severity of hepatic dysfunction was found to be correlated with HF (r--0.76, p=0.004), rMSSD (r—0.69, p=0.029) and SD (r=+0.63, p=0.02). It was concluded that in cirrhosis sympathetic and parasympathetic components of ANS dete-rioratcd and this deterioration was correlated to the severity of hepatic dysfunction.
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Abstract (Original Language): 
Kronik karaciğer hastaiannda (KKH) otonom sinir sistemi (OSS) fonksiyon bozukluğu görülmektedir. Çalışmamızın amacı karaciğer sirozlu (KS) hastalarda görülen OSS fonksiyon bozukluğunun sirozun ağırlığıyla olan ilişkisinin Kalp Hızı Değişkenliği (KHD) ile değerlendirilmesidir. Çalışmamızın hasta grubunu yaş ortalaması 48+9 olan 13 ü erkek 2 si kadın 15 alkole bağlı olmayan karaciğer sirozlu (KS) hasta, kontrol grubunu da yaş ortalaması 47+10 olan 13 ü erkek, 2 si kadın 15 sağlıklı kişi oluşturdu. Hastaların 5 tanesi (%33) Child A, 6 tanesi (% 40) Child B, 4 tanesi (%27) Child C grubundaydı. Hasta grubunda sol atriyum çaplan (SAÇ) normalden geniş ve fark anlamlı bulundu (4.13+0.53 cm e karşın 3.4+0.5 cm, p=0,006). Sirozlu hastalarda interventriküler septum (İVS) kalınlığı normal sınırlar içinde fakat kontrol grubundan kaim bulundu vc fark istatistik olarak hafif anlamlıydı (0.09+0.18 cm e karşın 0.92+0.17 cm, p=0.04). Sirozlularda "zaman-alan analizi" (ZAA) (time-domain) ve "frekans-alan analizi" (FAA) (frequency-domain) nin tüm parametrelerinde anlamlı derecede düşme tespit edildi; pNN50 (Arka arkaya gelen RR sikluslarmdan farkı 50 ms nin üzerinde olanların oram): İ.46+3.1 karşın 8.45+6.1, p=0.0001, S 0.01 (toplam spektral güç) (spektrum eğrisinin 0.01 den 1 Hz e kadar olan alanı) (TP): 15.5+6.0 karşın 39.6±7.7, p<0.0001, S 0.04 (düşük frekans gücü) (spektrum eğrisinin 0.04 ten 0.15 Hz e kadar olan alanı) (LF):9.9±4.6 karşm 26.8+4.9, p<0.0001, S 0.15 (yüksek frekans gücü) (spektrum eğrisinin 0.15 ten 0.40 Hz e kadar olan alanı) (HF): 5.5+2.0 karşın 12.7+4.8, p=0.0001, SD (5 er dakikalık dönemlerin RR aralıklarının standart sapmalarının ortalaması): 27.3±8.5 karşın 58.8+12.4, p<0.0001, SDANN (5 er dakikalık dönemlerin RR aralıklarının ortalamalarının standart sapması): 35+22.1 karşın 141+27.2, p<0.0001, SDNN (Tüm normal RR aralıklarının standart sapması): 73.1+23.2 karşm 152+27.7, p<0.0001, rMSSD (iki ardışık RR aralığının karelerinin toplamının ortalamasının karekökü): 15.5+7.0 karşın 30.9+10.0, p=0.0001). Korelasyon testlerinde Child-Pugh skorü-fle HF (p=0.004, r=-0.76), rMSSD (p=0.029, r=-0.62) ve SD (p=0.02, r=-0.63) arasında negatif yönde korelasyon olduğu tespit edilmiştir. Bu bulgular bize karaciğer sirozunda hem sempatik hem de parasempatik (PS) OSS fonksiyonlarının bozulduğunu, PS fonksiyonların karaciğer fonksiyonlarındaki bozulmaya paralel olarak azaldığını göstermektedir.
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  • Turkish

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