STATUS OF HEART RATE VARIABILITY PARAMETERS IN PATIENTS WITH CHRONIC PANCREATITIS DEPENDING ON BODY MASS INDEX
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i3.13295Keywords:
chronic pancreatitis, autonomic nervous system, heart rate variabilityAbstract
SUMMARY. The article analyzes the state of the autonomic nervous system in patients with CP, in particular by indicators of heart rate variability, depending on the body mass index (BMI).
The aim – to investigate parameters of heart rate variability in patients with CP and evaluate their relationship with predictors of disease severity.
Material and Methods. 100 patients with a diagnosis of CP who were treated on an outpatient basis in Ternopil institutions were examined. The body mass index was determined, and the state of the autonomic nervous system was also analyzed: the initial tone of the autonomic nervous system – based on the stress index (SI), Kerdo index (IK), autonomic support – using an active clinoorthostatic test. The following indicators of heart rate variability (HRV) were evaluated: variation spread, fashion amplitude, stress index, indicator of adequacy of regulation processes, vegetative rhythm indicator. Correlation analysis of the HRV parameters obtained with CP duration, age, faecal α-elastase level, IK was carried out.
Results. According to Kerdo's index, normotonic initial autonomic tone prevailed among patients with CP – in 46.0 % (n=46), the average IK value (-8.7±1.8) also corresponded to normotonicity. IK in the subgroup of patients with increased weight was (-17.77±2.52), which corresponds to moderate parasympatheticotonia, in persons with normal BMI it was within the limits of normotonia (-6.0±2.43), in patients with reduced body weight, which are characterized by the longest course of CP among the subgroups, observed a tendency to sympathicotonia with an index value of 0.26±4.49. Pathological reactions of hemodynamics to the clinoorthostatic test prevailed in those examined with chronic pancreatitis, the most numerous was the asympaticotonic variant, which indicates exhaustion of the compensatory mechanisms of autonomic tone regulation. Analyzing the HRV of people with CP, a tendency to sympathicotonia was found among them, which was accompanied by a significant increase relative to the control group of the amplitude of the fashion, the tension index, the indicator of the adequacy of the regulation processes, the autonomic rhythm indicator and a decrease in the range of variation. A reliable direct correlation of moderate strength was established between the level of initial tone of the ANS according to SI and IK (r=0.361, p<0.01). After conducting a correlation analysis of statistical parameters of HRV and indices for assessing the adaptation of the cardiovascular system to stress factors, we established the presence of their statistically reliable relationships with the duration of CP, the age of patients, and the level of fecal α-elastase.
Conclusions. It was proved that patients with CP are characterized by disorders on the part of the ANS – it was stated that the initial predominance of vagotonia with increasing duration of the disease and deepening of exocrine insufficiency is replaced by compensatory activation of the sympathetic division of the ANS. The obtained data motivate the inclusion of vegetotropic agents in the complex therapy of patients with chronic pancreatitis.
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