[논문]신체 증상 장애 환자의 심박변이도와 증상 심각도의 연관성

김은환; 김희선; 함진실; 김준범; 오주영

doi:10.22722/kjpm.2023.31.2.108

신체 증상 장애 환자의 심박변이도와 증상 심각도의 연관성
Associations Between Heart Rate Variability and Symptom Severity in Patients With Somatic Symptom Disorder 원문보기

정신신체의학 = Korean journal of psychosomatic medicine, v.31 no.2, 2023년, pp.108 - 117

김은환 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) , 김희선 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) , 함진실 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) , 김준범 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) , 오주영 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소)

초록
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연구목적 신체 증상 장애(Somatic Symptom Disorder, SSD)는 다양한 신체 증상의 발현을 특징으로 하며, 현재까지 환자군 내에서 증상 심각도에 따른 자율신경계 활성의 차이에 대해서는 연구된 바가 거의 없다. 이에 본 연구에서는 신체 증상 장애 환자군에서 심박변이도(Heart Rate Variability, HRV) 차이를 검정하여 증상 심각도에 따른 자율신경계 변화를 반영하는 대표적 지표를 분석하였다. 방 법 2020년 9월 18일부터 2021년 10월 29일까지 강남세브란스병원 정신건강의학과에 내원했던 환자 중, DSM-5 진단 기준에 따라 SSD로 진단받은 환자 총 51명의 의무기록을 후향적으로 수집하였다. 이후, 집단 간 인구사회학 및 임상적 선택편의 보정을 위해 역확률 가중치(Inverse Probability Treatment Weighting, IPTW)를 적용하여 HRV 지표 차이 검정을 실시하였다. 결 과 신체 증상 심각도와 LF (nu), HF (nu), LF/HF, 그리고 SD1/SD2, Alpha1/Alpha2는 통계적으로 유의한 상관관계를 보였으며, IPTW 적용 후 비중증군은 27명(53.0%), 중증군은 24명(47.0%)로 보정되었고, 인구사회학적 요인 및 임상적 특성 차이가 유의미하지 않아 동질성이 확보되었다. 본 모형 분석 결과 고위험군일수록 시간 영역의 RMSSD (β=-0.70, p=0.003), pNN20 (β=-1.04, p=0.019), 주파수 영역은 LF (nu) (β=0.29, p<0.001), HF (nu) (β=-0.29, p<0.001), LF/HF (β=1.41, p=0.001), 그리고 비선형 영역에서는 SampEn15 (β=-0.35, p=0.014), SD1/SD2 (β=-0.68, p<0.001), Alpha1/Alpha2 (β=0.43, p=0.001)에서 유의미한 차이가 검정되었다. 결 론 신체 증상 심각도에 따른 HRV 지표의 차이는 시간과 주파수 영역, 그리고 비선형 영역 전반에서 검정되었으며, 신체 증상이 심할수록 교감신경의 과활성화 및 부교감신경의 저하를 시사하는 HRV 지표들이 유의미하게 높은 경향성을 보였다.

Abstract ▼ AI-Helper

Objectives : Somatic symptom disorder (SSD) is characterized by the manifestation of a variety of physical symptoms, but little is known about differences in autonomic nervous system activity according to symptom severity, especially within patient groups. In this study, we examined differences in heart rate variability (HRV) across symptom severity in a group of SSD patients to analyze a representative marker of autonomic nervous system changes by symptoms severity. Methods : Medical records were retrospectively reviewed for patients who were diagnosed with SSD based on DSM-5 from September 18, 2020 to October 29, 2021. We applied inverse probability of treatment weighting (IPTW) methods to generate more homogeneous comparisons in HRV parameters by correcting for selection biases due to sociodemographic and clinical characteristic differences between groups. Results : There were statistically significant correlations between the somatic symptom severity and LF (nu), HF (nu), LF/HF, as well as SD1/SD2 and Alpha1/Alpha2. After IPTW estimation, the mild to moderate group was corrected to 27 (53.0%) and the severe group to 24 (47.0%), and homogeneity was achieved as the differences in demographic and clinical characteristics were not significant. The analysis of inverse probability weighted regression adjustment model showed that the severe group was associated with significantly lower RMSSD (β=-0.70, p=0.003) and pNN20 (β=-1.04, p=0.019) in the time domain and higher LF (nu) (β=0.29, p<0.001), lower HF (nu) (β=-0.29, p<0.001), higher LF/HF (β=1.41, p=0.001), and in the nonlinear domain, significant differences were tested for SampEn15 (β=-0.35, p=0.014), SD1/SD2 (β=-0.68, p<0.001), and Alpha1/Alpha2 (ß=0.43, p=0.001). Conclusions : These results suggest that differences in HRV parameters by SSD severity were showed in the time, frequency and nonlinear domains, specific parameters demonstrating significantly higher sympathetic nerve activity and reduced ability of the parasympathetic nervous system in SSD patients with severe symptoms.

주제어

표/그림 (4)

표 Table 1. Baseline sample characteristics before and after IPTW adjustment by PHQ-15 score
표 Table 2. Correlations between variables of interest
표 Table 3. Comparison of HRV parameters and analysis of outcomes before and after IPTW
표 Table 4. Inverse Probability Weighted Regression Adjusted (IP-WRA) results

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