| Objective: Depression is often accompanied by a variety of somatic symptoms,cardiovascular disease and gastrointestinal symptoms are the most common.This physical discomfort may even be the main reason for the initial visit of patients with depression,the onset of which is often associated with a greater degree of depression and worse prognosis.Some researchers consider that the physical discomfort is due to the imbalance of autonomic nerve function,that is,the increase of sympathetic regulation and the decrease of parasympathetic regulation.At present,the research results of cardiac autonomic nerve in patients with depression are not consistent,and the research of gastric autonomic nerve function in patients with depression at home and abroad is not in-depth.In addition,clinicians can only diagnose depression through clinical interviews and subjective self-reports with test scales,lacking biological indicators to identify and diagnose depression.Therefore,we recorded the electromyographic signals of the heart and stomach of patients with depression to analyze the autonomic nerve function of the heart and stomach,providing a reference for the clinical diagnosis of depression.At the same time,we analyzed whether the autonomic nerve changes were associated with somatic symptoms.Methods: All the subjects including depression groups(60)and the control group(61)were carefully interviewed by two experienced psychiatrists on the day of admission,and the subjects were evaluated using the Hamilton depression scale and the autonomic symptom rating scale.After a night of fasting(>8h),the EGG recording was made for 30 min in the fasting state and another 30 min after a standard test meal in the morning.A 12-lead portable electrocardiograph was used to record the subjects’ 24-hour long range electrocardiogram.The results were analyzed by professional physicians,and data related to heart rate variability and electrogastrogram were collected.Statistical analysis was conducted to compare the differences in heart rate variability and electrogastrogram between the depressed patients and the normal control group,and to analyze the changes in the autonomic nerves functions of the heart and stomach in the depressed patients,as well as whether these changes were related to the existence of somatic symptoms and severity of the disease.Results: Comparing the ECG measurements of the two groups by t test,SDNN,RMSSD,PNN50,HF and LF(P < 0.005)of the depressed patients were lower than that of the normal control group,and the LF/HF(P = 0.003)was higher than that of the normal control group,the difference was statistically significant.There was no statistically significant difference in maximum heart rate between the two groups(P =0.579),while the minimum heart rate in the depression group was significantly higher than that in the control group(P = 0.0009).The two-way ANOVA showed that the percentage of slow wave before and after meal in the depressed patients was significantly lower than that in the normal control group,and the difference was statistically significant [F(1,119)= 18.15;P < 0.0001].In the Bonferroni analysis,the slow wave percentage of the depressed patients was lower than that of the normal control group before(P=0.030)and after(P=0.0008),and the difference was statistically significant.The percentage of tachycardia before and after meal in patients with depression was significantly higher than that in the control group [(F(1,119)= 17.82;P < 0.0001].After the Bonferroni analysis,the percentage of postprandial tachycardia before(P=0.034)and after(P=0.003)meal in patients with depression was higher than that in the control group,and the difference was statistically significant.There was no significant difference in EEG parameters between depressed patients with gastrointestinal symptoms and those without gastrointestinal symptoms.There was a significant positive correlation between ANS score and HAMD-21 score(r = 0.117;P = 0.007).In addition,we found that the heart rate variability parameter "SDNN" [r = 0.127;P < 0.005],"RMSSD" [r = 0.074;P =0.034] and "LF" [r = 0.099;P = 0.014] were significantly negatively correlated with ANS score.However,there was no significant correlation between ANS score and EEG in depressed patients.There was no significant correlation between hamd-21 score and HRV,or between HAMD-21 score and EEG parameters.Conclusions: Our findings suggest that the autonomic function of heart and stomach is abnormal in the depressed patients.Moreover,the dysfunction of gastric autonomic nerve was not associated with gastrointestinal symptoms.ANS score can provide a reference for evaluating autonomic nerve function in clinic.Electrogastrography and gastric autonomic function may be helpful in diagnosing depression,but further studies are needed to verify changes in the non-linear EGG measurements and to correlate them with other parameters of autonomic function,such as pupil light reflex,variability in blood pressure,and sympathetic skin response in MDD patients. |
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