关键词: 焦虑, 抑郁, 共病现象, 心率变异性

Abstract: Background　Both generalized anxiety disorder （GAD） and depressive disorder （MDD） could lead to reduction in heart rate variability （HRV），increasing the risk of comorbid cardiovascular diseases.However，the effects of anxiety and depression on HRV parameters and the underlying mechanisms are still unclear.And studies about the impact of comorbid MDD on HRV in GAD patients are also very rare.Objective　To investigate the relationships of HRV with GAD and MDD by examining HRV features in such patients.Methods　A total of 140 participants were recruited from Jiangxi Mental Hospital during January 2015 to December 2016，including 90 outpatients and inpatients〔30 with GAD alone（GAD group），30 with GAD and MDD（GAD and MDD group），and 30 with MDD alone（MDD group）〕，and 50 clinic health examinees（control group）．A survey was conducted to collect demographic data〔age，sex，BMI，systolic blood pressure（SBP），diastolic blood pressure（DBP），weekly exercise time〕 of patients group at baseline，and of the control group at one week after grouping using a clinician-developed demographic questionnaire.The 17-item version of Hamilton Anxiety Rating Scale（HAMA-17） and Hamilton Depression Rating Scale（HAMD） were used to identify anxiety and depression symptoms，respectively.HRV was measured in patients group at one week after treatment，and in control group at one week after grouping.And the measurement results，time-domain parameters〔standard deviation of average NN intervals （SDANN），and the square root of the mean squared differences of successive normal sinus intervals （RMSSD）〕，and frequency-domain parameters〔low frequency （LF） and high frequency （HF）〕，were analyzed.Pearson correlation analysis was used to assess the correlations of HAMA-17 and HAMD scores with HRV.Results　Sex ratio，mean age，BMI，SBP，DBP，and weekly exercise time did not differ significantly across the three patients groups and the control group （P>0.05）．GAD，and GAD with MDD groups had significantly higher mean HAMA-17 scores than MDD group and control group（P<0.05）．GAD with MDD and MDD groups showed higher mean HAMD scores than GAD group and control group（P<0.05）．Mean LF value of GAD with MDD group was much lower than that of other two patients groups and control group（P<0.05）．Mean LF value of GAD group was much lower than that of MDD group and control group（P<0.05）．Mean HF value of GAD with MDD group was much lower than that of other two patients groups and control group（P<0.05）．Mean HF value of GAD group was much lower than that of MDD group and control group（P<0.05）．MDD group showed much lower mean values of HF and LF than control group（P<0.05）．The values of HF and LF were lower in MDD group than those in control group（P<0.05）．Furthermore，LF，HF，and LF/HF values were negatively correlated with the scores of HAMA-17 and HAMD in GAD and MDD patients（P<0.05）．Conclusion　Our present study demonstrated that both GAD and MDD can lead to reduction in HRV，and HRV was significantly correlated with the severity of anxiety and depression，suggesting that reduced HRV might be a psychopathological indicator of GAD.Since GAD comorbid MDD may result in a further reduction in HRV，the risk of cardiovascular diseases in these patients need clinicians to pay more attention.

Key words: Anxiety, Depression, Comorbidity, Heart rate variability