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

摘要： 背景　广泛性焦虑障碍（GAD）和抑郁障碍（MDD）均可导致心率变异性（HRV）降低，进而增加其共病心血管疾病的风险。然而，焦虑和抑郁情绪对HRV参数的影响及其潜在机制仍不清楚，也缺少GAD共病MDD对患者HRV影响的相关研究。目的　探讨GAD和MDD对HRV参数的影响，以及GAD共病MDD的HRV特点。方法　选取2015年1月—2016年12月于江西省精神病院住院或门诊治疗的90例患者，其中GAD患者（GAD组）、GAD共病MDD患者（GAD共病MDD组）和MDD患者（MDD组）各30例，另选取2015年1月—2016年12月在江西省精神病院门诊体检的健康体检者50例作为健康对照组。GAD组、GAD共病MDD组和MDD组患者在接受治疗前，健康对照组在入组后1周内由临床医生使用自制的人口学资料表收集人口学资料（年龄、性别、体质指数、收缩压、舒张压、每周运动时间），并使用汉密尔顿焦虑量表（HAMA-17）和汉密尔顿抑郁量表（HAMD）分别评定焦虑、抑郁情况。GAD组、GAD共病MDD组和MDD组患者在开始治疗后1周内，健康对照组在入组后1周内完成HRV检查并进行分析，包括时域分析〔总的R-R间期标准差（SDNN），相邻RR间期的均方根（RMSSD）〕和频域分析〔低频功率（LF）、高频功率（HF）〕。HAMA-17评分和HAMD评分与HRV的相关性使用Pearson相关分析。结果　四组年龄、性别、体质指数、收缩压、舒张压、每周运动时间比较，差异均无统计学意义（P>0.05）。GAD组和GAD共病MDD组HAMA-17评分高于MDD组、健康对照组（P<0.05）；GAD共病MDD组和MDD组HAMD评分高于GAD组、健康对照组（P<0.05）。GAD组和GAD共病MDD组LF低于MDD组、健康对照组，GAD共病MDD组LF低于GAD组（P<0.05）；GAD组和GAD共病MDD组HF低于MDD组、健康对照组，GAD共病MDD组HF低于GAD组（P<0.05）。MDD组HF、LF均低于健康对照组（P<0.05）。GAD共病MDD患者LF、HF、LF/HF与HAMA-17、HAMD评分呈负相关（P<0.05）。结论　GAD和MDD均可导致HRV降低，且与焦虑和抑郁的严重程度相关。GAD共病MDD可能导致更低的HRV，需要临床医生关注其发生心血管疾病风险。

关键词: 焦虑, 抑郁, 共病现象, 心率变异性