胃癌患者围手术期心率变异度与炎性指标的相关性

doi:10.6040/j.issn.1671-7554.0.2025.0490

摘要/Abstract

摘要： 目的探讨胃癌患者围手术期心率变异度(heart rate variability, HRV)与炎性指标、康复规律之间的关系。方法采用回顾性研究方法。收集2022年3月至2024年12月南京中医药大学附属医院收治的85例行腹腔胃癌根治术患者的一般资料,检测术前第1天和术后第1、第3天的HRV:SDNN、SDANN Index、PNN50、LF、HF,以及各血清炎性指标:超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)、白细胞(white blood cell, WBC)、白细胞介素-2(interleukin-2, IL-2)、白细胞介素-6(interleukin-6, IL-6)、白介素-1β(interleukin-1β, IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)及γ干扰素(interferon-γ, IFN-γ),分析HRV与炎性指标的相关性,以及术后第1天HRV和炎性指标与术后康复指标的相关性。采用核心诊断效能分析方法构建受试者工作特征(receiver operating characteristic, ROC)曲线评估HRV预测胃癌术后48 h内通气的效能。结果术前第1天,SDNN与hs-CRP(r=-0.25)、SDANN Index与WBC(r=-0.25)、LF与IL-1β(r=-0.28)及TNF-α(r=-0.26)呈负相关(P均<0.05);术后第1天,SDNN与hs-CRP(r=-0.46)、WBC(r=-0.33)、IL-2(r=-0.25)、IL-6(r=-0.40),PNN50与hs-CRP(r=-0.40)、WBC(r=-0.36)、IL-6(r=-0.33),LF与(r=-0.32)、WBC(r=-0.21)、IL-2(r=-0.53)、IL-6(r=-0.39),HF与hs-CRP(r=-0.50)、IL-2(r=-0.40)、IL-6(r=-0.60)均呈负相关(P均<0.05);术后第3天,SDNN与hs-CRP(r=-0.35)、WBC(r=-0.29)、IL-2(r=-0.24)、IL-6(r=-0.27),PNN50与WBC(r=-0.49)、IL-2(r=-0.25)、IL-6(r=-0.28)、TNF-α(r=-0.23),LF与hs-CRP(r=-0.39)、WBC(r=-0.28)、IL-2(r=-0.45),HF与hs-CRP(r=-0.42)、WBC(r=-0.39)、IL-2(r=-0.44)、IL-6(r=-0.27)均呈负相关(P均<0.05)。康复指标中,术后首次通气时长(r=0.47)、肠鸣音恢复时间(r=0.36)与 WBC 呈正相关,术后第1天 VAS 评分与hs-CRP(r=-0.22)、IFN-γ(r=-0.23)呈负相关,术后通气时长(r=-0.22)、下床活动时间(r=-0.23)、肠鸣音恢复时间(r=-0.30)与 SDNN 呈负相关(P均<0.05);LF 预测术后48 h内通气有统计学意义(AUC=0.671 5, P=0.009 3)。结论胃癌患者围手术期HRV与炎性指标显著负相关,HRV有望成为一种新型的、无创的围手术期应激状态数字标志物,预测患者的术后康复规律。

关键词: 心率变异度, 自主神经功能, 炎性指标, 手术应激, 预测康复

Abstract: Objective To investigate the correlation between perioperative heart rate variability(HRV), inflammatory markers, and recovery patterns in patients with gastric cancer. Methods The present retrospective study involved 85 patients who underwent laparoscopic radical gastrectomy and were hospitalized at Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to December 2024. Patients included 58 males and 27 females with the age of(64.7±10.3)years. HRV indices(SDNN, SDANN Index, PNN50, LF, HF)and serum inflammatory markers(hs-CRP, WBC, IL-2, IL-6, IL-1β, TNF-α, IFN-γ)were assessed before surgery, and on postoperative days 1 and 3. The study examined the correlations between HRV and inflammatory markers, as well as between HRV/inflammatory markers on postoperative day 1 and postoperative recovery indicators. A receiver operating characteristic(ROC)curve was generated using core diagnostic performance analysis to assess the predictive value of HRV for postoperative flatus within 48 hours following gastric cancer surgery. Results On preoperative day 1, SDNN exhibited a negative correlation with hs-CRP(r=-0.25), the SDANN Index correlated negatively with WBC(r=-0.25), and LF was negatively correlated with IL-1β(r=-0.28)and TNF-α(r=-0.26)(all P<0.05). On postoperative day 1, negative correlations were identified as follows: SDNN with hs-CRP(r=-0.46), WBC(r=-0.33), IL-2(r=-0.25), and IL-6(r=-0.40); PNN50 with hs-CRP(r=-0.40), WBC(r=-0.36), and IL-6(r=-0.33); LF with hs-CRP(r=-0.32), WBC(r=-0.21), IL-2(r=-0.53), and IL-6(r=-0.39); and HF with hs-CRP(r=-0.50), IL-2(r=-0.40), and IL-6(r=-0.60)(all P<0.05). On postoperative day 3, the following negative correlations were observed: SDNN with hs-CRP(r=-0.35), WBC(r=-0.29), IL-2(r=-0.24), and IL-6(r=-0.27); PNN50 with WBC(r=-0.49), IL-2(r=-0.25), IL-6(r=-0.28), and TNF-α(r=-0.23); LF with hs-CRP(r=-0.39), WBC(r=-0.28), and IL-2(r=-0.45); and HF with hs-CRP(r=-0.42), WBC(r=-0.39), IL-2(r=-0.44), and IL-6(r=-0.27)(all P<0.05). Additionally, postoperative initial flatus time(r=0.47)and bowel sound recovery time(r=0.36)were positively correlated with WBC. The Visual Analog Scale(VAS)score on postoperative day 1 showed a negative correlation with hs-CRP(r=-0.22)and IFN-γ(r=-0.23). Furthermore, postoperative flatus time(r=-0.22), ambulation time(r=-0.23), and bowel sound recovery time(r=-0.30)were negatively correlated with SDNN(all P<0.05). LF significantly predicted postoperative flatus within 48 hours(AUC=0.671 5, P=0.009 3). Conclusion Patients with gastric cancer show significant inverse correlations between perioperative HRV and inflammatory markers. HRV is expected to be a novel, non-invasive digital biomarker for perioperative stress states, thereby enabling prediction of postoperative recovery patterns in patients.

Key words: Heart rate variability, Autonomic nervous function, Inflammatory markers, Surgical stress, Recovery prediction

中图分类号:

R619

王烨,王刚,南海鸥,蔡雨玲,李嘉宇,王海锋,颜英杰,江志伟. 胃癌患者围手术期心率变异度与炎性指标的相关性[J]. 山东大学学报 (医学版), 2026, 64(4): 23-30.

WANG Ye, WANG Gang, NAN Haiou, CAI Yuling, LI Jiayu, WANG Haifeng, YAN Yingjie, JIANG Zhiwei. Correlation between perioperative heart rate variability and inflammatory indicators in gastric cancer patients[J]. Journal of Shandong University (Health Sciences), 2026, 64(4): 23-30.

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