帕金森病与心率变异性关系的Meta分析
A Meta-Analysis of the Relationship between Parkinson’s Disease and Heart Rate Variability
DOI: 10.12677/acm.2025.1541223, PDF,   
作者: 刘致春, 吴佳和, 姜雨希：黑龙江中医药大学研究生院，黑龙江 哈尔滨；程为平*：黑龙江中医药大学附属第一医院针灸二科，黑龙江 哈尔滨
关键词: 帕金森病；心率变异性；Meta分析；Parkinson’s Disease； Heart Rate Variability； Meta-Analysis
摘要: 目的：探讨帕金森病(PD)与心脏自主神经功能损伤的相关性。方法：计算机检索Pubmed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方(Wanfang)、维普(VIP)数据库，检索时限均为建库至2023年11月25日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.4软件和Stata软件进行Meta分析。结果：共纳入17项研究，包括404例患者和430例健康对照。Meta分析结果显示：PD患者的HF [SMD: −0.28, CI (−0.53, −0.03), P = 0.03]、TP [SMD: −1.31, CI (−1.74, −0.88), P < 0.001]、RMSSD [SMD: −0.84, CI (−1.06, −0.62), P < 0.001]、SDNN [SMD:−0.45, CI (−0.70, −0.21), P < 0.001]、pNN50 [SMD: −1.21, CI (−2.29, −0.13), P = 0.03]均低于对照组，而两组在LF [SMD: −0.17, CI (−0.55, 0.22), P = 0.40]和LF/HF [SMD: 0.04, CI (−0.54, 0.62), P = 0.10]的差异无统计学意义。结论：PD患者的HRV明显低于正常健康人，表明PD与心脏自主神经损伤存在联系。
Abstract: Objective: To explore the correlation between Parkinson’s disease (PD) and cardiac autonomic nerve function damage. Methods: Computerized searches were conducted in Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases from their inception to November 25, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 and Stata software. Results: A total of 17 studies were included, involving 404 patients with PD and 430 healthy controls. The meta-analysis results showed that the HF [SMD: −0.28, CI (−0.53, −0.03), P = 0.03], TP [SMD: −1.31, CI (−1.74, −0.88), P < 0.001], RMSSD [SMD: −0.84, CI (−1.06, −0.62), P < 0.001], SDNN [SMD: −0.45, CI (−0.70, −0.21), P < 0.001], and pNN50 [SMD: −1.21, CI (−2.29, −0.13), P = 0.03] of patients with PD were all lower than those of the control group, while there was no statistically significant difference in LF [SMD: −0.17, CI (−0.55, 0.22), P = 0.40] and LF/HF [SMD: 0.04, CI (−0.54, 0.62), P = 0.10] between the two groups. Conclusion: The HRV of patients with PD is significantly lower than that of normal healthy individuals, indicating a connection between PD and cardiac autonomic nerve damage.
文章引用：刘致春, 吴佳和, 姜雨希, 程为平. 帕金森病与心率变异性关系的Meta分析[J]. 临床医学进展, 2025, 15(4): 2639-2649. https://doi.org/10.12677/acm.2025.1541223

参考文献

[1] 中华医学会神经病学分会帕金森病及运动障碍学组. 中国帕金森病治疗指南(第三版) [J]. 中华神经科杂志, 2014, 47(6): 428-433.
[2] Ziemssen, T. and Reichmann, H. (2010) Cardiovascular Autonomic Dysfunction in Parkinson’s Disease. Journal of the Neurological Sciences, 289, 74-80. [Google Scholar] [CrossRef] [PubMed]
[3] Braak, H., Tredici, K.D., Rüb, U., de Vos, R.A.I., Jansen Steur, E.N.H. and Braak, E. (2003) Staging of Brain Pathology Related to Sporadic Parkinson’s Disease. Neurobiology of Aging, 24, 197-211. [Google Scholar] [CrossRef] [PubMed]
[4] Pham, T., Lau, Z.J., Chen, S.H.A. and Makowski, D. (2021) Heart Rate Variability in Psychology: A Review of HRV Indices and an Analysis Tutorial. Sensors, 21, Article No. 3998. [Google Scholar] [CrossRef] [PubMed]
[5] Mejía-Mejía, E., Budidha, K., Abay, T.Y., May, J.M. and Kyriacou, P.A. (2020) Heart Rate Variability (HRV) and Pulse Rate Variability (PRV) for the Assessment of Autonomic Responses. Frontiers in Physiology, 11, Article No. 779. [Google Scholar] [CrossRef] [PubMed]
[6] Xhyheri, B., Manfrini, O., Mazzolini, M., Pizzi, C. and Bugiardini, R. (2012) Heart Rate Variability Today. Progress in Cardiovascular Diseases, 55, 321-331. [Google Scholar] [CrossRef] [PubMed]
[7] Luo, D., Wan, X., Liu, J. and Tong, T. (2016) Optimally Estimating the Sample Mean from the Sample Size, Median, Mid-Range, and/or Mid-Quartile Range. Statistical Methods in Medical Research, 27, 1785-1805. [Google Scholar] [CrossRef] [PubMed]
[8] Wan, X., Wang, W., Liu, J. and Tong, T. (2014) Estimating the Sample Mean and Standard Deviation from the Sample Size, Median, Range and/or Interquartile Range. BMC Medical Research Methodology, 14, Article No. 135. [Google Scholar] [CrossRef] [PubMed]
[9] Kallio, M., Haapaniemi, T., Turkka, J., Suominen, K., Tolonen, U., Sotaniemi, K., et al. (2000) Heart Rate Variability in Patients with Untreated Parkinson’s Disease. European Journal of Neurology, 7, 667-672. [Google Scholar] [CrossRef] [PubMed]
[10] Haapaniemi, T.H. (2001) Ambulatory ECG and Analysis of Heart Rate Variability in Parkinson’s Disease. Journal of Neurology, Neurosurgery & Psychiatry, 70, 305-310. [Google Scholar] [CrossRef] [PubMed]
[11] Pursiainen, V., Haapaniemi, T.H., Korpelainen, J.T., Huikuri, H.V., Sotaniemi, K.A. and Myllylä, V.V. (2002) Circadian Heart Rate Variability in Parkinson’s Disease. Journal of Neurology, 249, 1535-1540. [Google Scholar] [CrossRef] [PubMed]
[12] Guieu, J.D., Libersa, C., Destee, A., Devos, D., Kroumova, M., Bordet, R., et al. (2003) Heart Rate Variability and Parkinson’s Disease Severity. Journal of Neural Transmission, 110, 997-1011. [Google Scholar] [CrossRef] [PubMed]
[13] Bouhaddi, M., Vuillier, F., Fortrat, J.O., Cappelle, S., Henriet, M.T., Rumbach, L., et al. (2004) Impaired Cardiovascular Autonomic Control in Newly and Long-Term-Treated Patients with Parkinson’s Disease: Involvement of L-Dopa Therapy. Autonomic Neuroscience, 116, 30-38. [Google Scholar] [CrossRef] [PubMed]
[14] Suominen, K., Haapaniemi, T., Sotaniemi, K., Myllyl, V.V., Astafiev, S., Tolonen, U., et al. (2004) Nocturnal Cardiac Autonomic Regulation in Parkinson’s Disease. Clinical Autonomic Research, 14, 119-124. [Google Scholar] [CrossRef] [PubMed]
[15] Buob, A., Winter, H., Kindermann, M., Becker, G., Möller, J.C., Oertel, W.H., et al. (2010) Parasympathetic but Not Sympathetic Cardiac Dysfunction at Early Stages of Parkinson’s Disease. Clinical Research in Cardiology, 99, 701-706. [Google Scholar] [CrossRef] [PubMed]
[16] Oka, H., Toyoda, C., Yogo, M. and Mochio, S. (2011) Cardiovascular Dysautonomia in De Novo Parkinson’s Disease without Orthostatic Hypotension. European Journal of Neurology, 18, 286-292. [Google Scholar] [CrossRef] [PubMed]
[17] Liou, L., Ruge, D., Chang, Y., Wu, M., Hsu, C., Lin, C., et al. (2013) Functional Connectivity between Lateral Premotor-Parietal Circuits and the Cardiac Autonomic System in Parkinson’s Disease. Journal of the Neurological Sciences, 326, 48-52. [Google Scholar] [CrossRef] [PubMed]
[18] 王海峰, 汪咏秋, 卢苗青, 等. 帕金森病患者心脏自主神经功能的临床研究[J]. 现代实用医学, 2013, 25(04): 396-398.
[19] Asahina, M., Mathias, C.J., Katagiri, A., Low, D.A., Vichayanrat, E., Fujinuma, Y., et al. (2014) Sudomotor and Cardiovascular Dysfunction in Patients with Early Untreated Parkinson’s Disease. Journal of Parkinson’s Disease, 4, 385-393. [Google Scholar] [CrossRef] [PubMed]
[20] Strano, S., Fanciulli, A., Rizzo, M., Marinelli, P., Palange, P., Tiple, D., et al. (2016) Cardiovascular Dysfunction in Untreated Parkinson’s Disease: A Multi-Modality Assessment. Journal of the Neurological Sciences, 370, 251-255. [Google Scholar] [CrossRef] [PubMed]
[21] Yoon, J.H., Kim, M.S., Lee, S.M., Kim, H.J. and Hong, J.M. (2016) Heart Rate Variability to Differentiate Essential Tremor from Early-Stage Tremor-Dominant Parkinson’s Disease. Journal of the Neurological Sciences, 368, 55-58. [Google Scholar] [CrossRef] [PubMed]
[22] Rocchi, C., Placidi, F., Liguori, C., Del Bianco, C., Lauretti, B., Diomedi, M., et al. (2018) Daytime Autonomic Activity in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Preliminary Study. Sleep Medicine, 52, 163-167. [Google Scholar] [CrossRef] [PubMed]
[23] Matei, D., Luca, C., Andritoi, D., Fuior, R., Zaharia, D., Onu, I., et al. (2019) Autonomic Dysfunction and Peripheral Nerve Involvement in Patients with Parkinson’s Disease. Balneo Research Journal, 10, 55-61. [Google Scholar] [CrossRef] 
[24] Arnao, V., Cinturino, A., Mastrilli, S., Buttà, C., Maida, C., Tuttolomondo, A., et al. (2020) Impaired Circadian Heart Rate Variability in Parkinson’s Disease: A Time-Domain Analysis in Ambulatory Setting. BMC Neurology, 20, Article No. 152. [Google Scholar] [CrossRef] [PubMed]
[25] 何倩倩, 伏兵, 陈皆春, 等. 心率变异性与帕金森病病情进展的关系[J]. 中国基层医药, 2023, 30(10): 1451-1456.
[26] Dorsey, E.R., Sherer, T., Okun, M.S. and Bloem, B.R. (2018) The Emerging Evidence of the Parkinson Pandemic. Journal of Parkinson’s Disease, 8, S3-S8. [Google Scholar] [CrossRef] [PubMed]
[27] Schootman, M. (2012) Predictors of Survival in Patients with Parkinson Disease. Archives of Neurology, 69, 601-607. [Google Scholar] [CrossRef] [PubMed]
[28] Park, J., Kim, D., Park, Y., Kwon, D., Choi, M., Jung, J., et al. (2020) Association of Parkinson Disease with Risk of Cardiovascular Disease and All-Cause Mortality: A Nationwide, Population‑Based Cohort Study. Circulation, 141, 1205-1207. [Google Scholar] [CrossRef] [PubMed]
[29] Kincl, V., Panovský, R., Bočková, M., Rektor, I., Mojica‐Pisciotti, M.L. and Máchal, J. (2023) Parkinson’s Disease Cardiovascular Symptoms: A New Complex Functional and Structural Insight. European Journal of Neurology, 31, e16110. [Google Scholar] [CrossRef] [PubMed]
[30] 温清艳, 区浩林, 孙巧松, 等. 帕金森伴慢性心力衰竭患者心率变异性的变化特点及其与心功能指标和预后的关系[J]. 广东医学, 2017, 38(22): 3485-3487+3490.
[31] Suri, J.S., Paul, S., Maindarkar, M.A., Puvvula, A., Saxena, S., Saba, L., et al. (2022) Cardiovascular/Stroke Risk Stratification in Parkinson’s Disease Patients Using Atherosclerosis Pathway and Artificial Intelligence Paradigm: A Systematic Review. Metabolites, 12, Article No. 312. [Google Scholar] [CrossRef] [PubMed]
[32] Huckemann, S., Mueller, K., Averdunk, P., Kühn, E., Hilker, L., Kools, S., et al. (2022) Vagal Cross-Sectional Area Correlates with Parasympathetic Dysfunction in Parkinson’s Disease. Brain Communications, 5, fcad006. [Google Scholar] [CrossRef] [PubMed]
[33] Goldstein, D.S., Bentho, O., Park, M. and Sharabi, Y. (2011) Low-Frequency Power of Heart Rate Variability Is Not a Measure of Cardiac Sympathetic Tone but May Be a Measure of Modulation of Cardiac Autonomic Outflows by Baroreflexes. Experimental Physiology, 96, 1255-1261. [Google Scholar] [CrossRef] [PubMed]
[34] Heathers, J.A.J. (2014) Everything Hertz: Methodological Issues in Short-Term Frequency-Domain HRV. Frontiers in Physiology, 5, Article No. 177. [Google Scholar] [CrossRef] [PubMed]
[35] Heimrich, K.G., Lehmann, T., Schlattmann, P. and Prell, T. (2021) Heart Rate Variability Analyses in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Brain Sciences, 11, Article No. 959. [Google Scholar] [CrossRef] [PubMed]
[36] Rodrigues, L.D., Oliveira, L.F., Shinoda, L., Scorza, C.A., Faber, J., Ferraz, H.B., et al. (2019) Cardiovascular Alterations in Rats with Parkinsonism Induced by 6-OHDA and Treated with Domperidone. Scientific Reports, 9, Article No. 8965. [Google Scholar] [CrossRef] [PubMed]
[37] Javanshiri, K., Drakenberg, T., Haglund, M. and Englund, E. (2022) Cardiac Alpha-Synuclein Is Present in Alpha-Synucleinopathies. Journal of Parkinson’s Disease, 12, 1125-1131. [Google Scholar] [CrossRef] [PubMed]
[38] Pignolo, A., Mastrilli, S., Davì, C., Arnao, V., Aridon, P., dos Santos Mendes, F.A., et al. (2022) Vitamin D and Parkinson’s Disease. Nutrients, 14, Article No. 1220. [Google Scholar] [CrossRef] [PubMed]
[39] Rizzoni, D., Rizzoni, M. and Nardin, M. (2019) Vitamin D and Ischaemic Heart Disease: A Casual or a Causal Association? Commentary on: “Raslan E et al. Association of Vitamin D Deficiency with Chronic Stable Angina: A Case‑Control Study”. High Blood Pressure & Cardiovascular Prevention, 26, 151-155. [Google Scholar] [CrossRef] [PubMed]
[40] Liu, X., Wang, W., Tan, Z., Zhu, X., Liu, M., Wan, R., et al. (2019) The Relationship between Vitamin D and Risk of Atrial Fibrillation: A Dose-Response Analysis of Observational Studies. Nutrition Journal, 18, Article No. 73. [Google Scholar] [CrossRef] [PubMed]
[41] Repici, M. and Giorgini, F. (2019) DJ-1 in Parkinson’s Disease: Clinical Insights and Therapeutic Perspectives. Journal of Clinical Medicine, 8, Article No. 1377. [Google Scholar] [CrossRef] [PubMed]
[42] Tsoporis, J.N., Drosatos, I., Gupta, S., Amatullah, H., Izhar, S., dos Santos, C.C., et al. (2021) Cytoprotective Mechanisms of DJ-1: Implications in Cardiac Pathophysiology. Molecules, 26, Article No. 3795. [Google Scholar] [CrossRef] [PubMed]

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