ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2020, 5(4): 222–228
https://doi.org/10.26693/jmbs05.04.222
Clinical Medicine

Vegetative Status in Extrahepatic Cholestasis in Patients with Cholelitiasis according to the Results of Heart Rate Variability Analysis (PRECISE Diagnostics)

Shevchenko B.F., Zeleniuk O.V., Zyhalo E.V., Prolom N.V., Babii O.M.
Abstract

The purpose of the study was to assess the autonomic status, adaptive potential and level of stress resistance in terms of heart rate variability in extrahepatic cholestasis in patients with complications of cholelithiasis. Material and methods. We examined 46 patients with extrahepatic cholestasis who were treated in the Department of Surgery of the Digestive System of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine for the period from 2013 to 2019. There were the following complications of cholelithiasis: chronic calculous cholecystitis in 4 patients, chronic calculous cholecystitis with choledocholitis in 12 patients, calculous cholecystitis with stenotic papillitis (stages 1, 2, 3) in 30 patients. Manifestations of extrahepatic cholestasis were established with the help of biochemical studies, ultrasound, and MRCP data. Depending on the nature of the extrahepatic cholestasis, patients were divided into groups. Group I consisted of 16 patients with extrahepatic cholestasis on the background of functional biliary disorders with Oddi sphincter dysfunction; group II included 30 patients with extrahepatic cholestasis on the background of stenotic papillitis (stages 1, 2, 3) with choledocholithiasis in 12 patients. Extrahepatic cholestasis was evaluated based on the results of PRECIZE diagnostics (cloud automated interpretation technology) using a CONTECT 8000GW electrocardiograph (China) with a bluetooth connection and software. To interpret the ECG results, a connection was made to the AMAZON web service. The following indicators were analyzed: sympathetic-vagal balance HF / LF to determine autonomic tone, stress index, RMSSD – the square root of the mean square of the difference of the values of successive pairs of intervals NN, which estimates the level of adaptation (quantification of depletion of adaptation reserves); stress index. Results and discussion. In the examined patients, the average values of the RMSSD index characterizing the adaptive capacity of the organism were within norm, but with a probable decrease in this indicator in patients of group II it was (35.1±4.6) m/s compared with the patients of group I (51.5±5.3) m / s (p <0.05). The analysis of the obtained data revealed that the first group was dominated by patients with normal adaptation (62.5%). The majority of patients in group II (83.3%) showed signs of maladaptation (failure of adaptation) with a decrease in RMSSD to (7.8±2.9) m / s (p <0.05), which indicated a weakening of parasympathetic effects on heart rhythm with possible subsequent complications of the disease in these patients. Our studies showed that most patients with extrahepatic cholestasis and functional biliary disorders (dysfunction) activation of the sympathetic autonomic nervous system, in contrast to patients with extrahepatic cholestasis with stenotic papillitis, who in the spectrum of identified autonomic nervous system disorders, had vagotonia (50.0%) with a decrease in sympatho-vagal balance by 0.48±0.14, and moderate sympathicotonia in 43.3% of patients with an increase in the ratio of LF / HF by 2.1±0.7 (p <0.05). Conclusion. Assessment of heart rate variability using PRECIZE diagnostics is a highly informative, convenient method, which allows assessing the state of the autonomic nervous system, adaptive capacity of the body in surgical patients, including the severity of stress, and can be recommended for use in screening differential diagnosis of functional and organic disorders in surgical patients with extrahepatic cholestasis on the background of complications of cholelithiasis.

Keywords: biliary tract, diagnosis, dysfunction, stenotic papillitis, gallstone disease

Full text: PDF (Ukr) 300K

References
  1. Labinskyy PA. Kharchovyy status ta mikronutriyentnyy balans u ditey z funktsionalnymy rozladamy biliarnogo traktu [Nutritional status and micronutrient balance in children with functional disorders of the biliary tract]. Abstr. PhDr. (Med.). Lviv; 2018. [Ukrainian]
  2. Loranskaya YD, Kukushkyn ML, Panyna NA. Bylyarnye dysfunktsyy y ykh profylaktyka. Eksperimental’naya i Klinicheskaya Gastroenterologiya [Biliary dysfunctions and their prevention]. Eksperimental'naia i klinicheskaia gastroenterologiia. 2011; 5: 48-52. [Russian]
  3. Kazyulin AN. Masky byllyarnoy dysfunktsyy zhelchevyvodyashchykh putey [Mascs of functional disorders of the biliary tract]. Eksperimental’naya i Klinicheskaya Gastroenterologiya. 2015; 2: 71-81. [Russian]
  4. Grydneva SV. Disfunktsiia sfinktera Oddi posle kholetsistektomii: mekhanizmy razvitiia i taktika lecheniia [Sphincter Oddi dysfunction after cholecystectomy: development mechanisms and treatment tactics]. Suchasna gastroenterologiia. 2015; 3(83): 122-7. [Russian]
  5. Sheptulin AA, Kardasheva SS. Spornye voprosy funktsyonalnykh rasstroystv zhyolchnogo puzyrya y sfynktera Oddy: analyz rymskykh kryteryev IV peresmotra (2016) [Controversial issues functional disorders of the gallbladder and sphincter Oddi: an analysis of the Roman criteria IV revision (2016 year)]. Klynycheskaya medytsyna. 2018; 96(1): 84-7. [Russian] doi: 10.18821/0023-2149-2018-96-1-84-87
  6. Mykryukov VYu. Dyagnostyka y lechenye dysfunktsyy sfynktera Oddy u bolnykh postkholetsystektomycheskym syndromom [Diagnosis and treatment of sphincter Oddi dysfunction in patients with postcholecystectomy syndrome]. Abstr. PhDr. (Med.). Perm; 2015. [Russian]
  7. Okhlobystyn AV. Rastroystva motoryky zhelchevyvodyashchykh putey v klynycheskoy praktyke [Biliary tract motility disorders in clinical practice]. Klynycheskye perspektyvy gastroenterologyy, gepatologyy. 2002; 3: 17-24. [Russian]
  8. Ilchenko A.A. Dysfunktsyonalnye rasstroystva bylyarnogo trakta [Dysfunctional Biliary Tract Disorders]. Consilium Medicum prylozhenye. 2002; 1: 20-3. [Russian]
  9. Sen J, McGill D. [Fractal analysis of heart rate variability as a predictor of mortality: A systematic review and meta-analysis]. Chaos: An Interdisciplinary Journal of Nonlinear Science. 2018; 28(7): 72-101. https://www.ncbi.nlm.nih.gov/pubmed/30070502. https://doi.org/10.1063/1.5038818
  10. Sessa F, Anna V, Messina G. [Heart rate variability as predictive factor for sudden cardiac death]. Aging (Albany NY). 2018; 10(2): 166-77. https://www.ncbi.nlm.nih.gov/pubmed/29476045 https://www.ncbi.nlm.nih.gov/pmc/articles/5842851 . https://doi.org/10.18632/aging.101386
  11. Prineas RJ, Crow RS, Zhang Z. [The Minnesota Code Manual of Electrocardiographic Findings including measurement and comparison with the Novacode . Standards and Procedures for ECG Measurement in Epidemiologic and Clinical Trials. Second Edition New and Enlarged. Springer-Verlag London Limited. 2010; 13: 328. https://doi.org/10.1007/978-1-84882-778-3
  12. PRECISE automated ECG interpretation. Calofornia 90291 United States; 2018.