更年期證型與自律神經相關性研究

Questionnaire of Menopausal Constitution By Modified Delphi Technique and The Correlation to Autonomic Nervous SYSTE M

目的：心率變異性（Heart rate variability, HRV）可代表自律神經的活性，根據過去研究顯示HRV是脈波的調控因素之一，可以代表脈診“數”的因子，且交感與副交感神經具陽陰平衡的概念，心跳間距（R-R interval）代表整體自律神經功能、高頻功率（HF）代表副交感神經活性、低頻功率比值（LF%）代表交感神經活性，本研究目的以心率變異性做為脈診“數”的客觀指標，應用在更年期症候群婦女的證型診斷輔助。方法：以修正型德菲法（Modified Delphi Technique）建立更年期體質量表，收集 - 0歲更年期受試者，測量體質量表及HRV。從HRV的HF和LF%導出陽陰平衡指標（Yang-yinindex），並進行體質量表與HRV相關參數的相關性分析。結果：總共施測 位更年期婦女，平均年齡 . ± . 歲，平均停經時間 . ±0. 年。經修正型德菲法建立更年期婦女體質量表，共分為 種證型：腎陰虛質、腎陽虛質、腎陰陽兩虛質、心血虛質、肝鬱化火質、脾虛質，整體量表具有相當良好的信效度（Cronbach's alpha= 0. ）。心血虛質分數、肝鬱化火質分數、脾虛質分數與RR 有顯著的負相關性（r 分別為–0. 、–0. 和–0. , p<0.0 ），心血虛質分數與HF 有顯著負相關（r= –0. , p<0.0 ）而與LF% 有顯著正相關（r= 0. , p<0.0 ）。在HRV 的陽陰平衡指標方面，心血虛質分數、肝鬱化火質分數皆與陽陰平衡指標成正相關（r= 0. , p<0.0 及r= 0. , p<0.0 ）。結論：HRV所衍生的陽陰平衡指標可作為更年期肝鬱化火證型診斷的客觀輔助指標。Purpose: Patterns identification combined with pulse diagnosis is an important form in clinical practice of Chinese medicine. However, it is lacking an objective uniform in patterns identification. Heart rate variability (HRV) is a non-invasive method to measure the autonomic nervous activity in human. The RR interval (RR), high frequency power (0.15-0.4Hz, HF) and the percentage of low frequency (LF%) of HRV represent the activity of cardiac autonomic nervous system, parasympathetic activity and sympathetic modulation, respectively. The aim of this study is to apply HRV as an objective parameter in the diagnosis patterns of women with menopausal syndrome. Methods: By using the modified Delphi Technique, we established the questionnaire of menopausal constitution (QMC). We enrolled women with menopause, age from 45 to 6 0 years old, to participate the fill-out of QMC. HRV was measured meanwhile and the yang-yin index was derived from the result of HRV. Results: Eighty-one menopausal women who met the inclusion criteria were enrolled in this study. The demography of the participant was: mean age 51 .5±4.8 years-old and duration of menopause 4.3±0.7 years. There were 6 types of constitution according to the QMC (total 37 items): kidney-yin deficiency, kidney-yang deficiency, kidney-yin/yang combined deficiency, heart blood deficiency, liver stagnation and spleen deficiency types. The Cronbach's alpha was 0.916 in the QMC, which represented the good content reliability in this questionnaire. The heart blood deficiency, liver stagnation and spleen deficiency scores had significantly negative correlation with the RR of HRV(r= –0.314, –0.297and –0.272, p<0.05, respectively). In addition, the heart blood deficiency scores had significantly negative correlation to the HF of HRV(r= –0.238, p<0.05) and positive correlation to the LF% of HRV(r= 0.224, p<0.05). The kidney-ying deficiency, kidney-yang deficiency and kidney-yin/yang combined deficiency scores were not significantly correlated to the parameters of HRV. We also found the yang-yin index had significantly positive correlation to the heart blood deficiency and liver stagnation types (r= 0.291, p<0.01 and r= 0.228, p<0.05, respectively). Conclusion: The yang-yin index, which was derived from the HRV, may be as an objective parameter to help the diagnosis liver stagnation type of menopausal syndrome.