Heart rate variability as a modifiable biomarker of clinical symptoms and psychological functioning in pediatric patients with inflammatory bowel disease

心率变异性作为炎症性肠病儿科患者临床症状和心理功能的可修改生物标志物

• 批准号: 10722740
• 负责人: Bonney Reed
• 金额: $ 23.48万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722740
• 关键词: Adolescent; Adult; Anxiety; Anxiety Disorders; Automobile Driving; Autonomic Dysfunction; Autonomic nervous system; Biofeedback; Biofeedback Training; Biological Markers; Cardiac; Central Nervous System; Child; Childhood; Chronic; Chronic Disease; Chronic stress; Clinical; Cognitive Therapy; Communication; Complex; Constipation; Coping Skills; Crohn' s disease; Data; Data Analyses; Depressive disorder; Diagnosis; Diarrhea; Disease; Distress; Elements; Emotional; Enrollment; Exhibits; Frequencies; Functional disorder; Gastrointestinal Diseases; Goals; Immune; Individual; Inflammatory Bowel Diseases; Intervention; Irritable Bowel Syndrome; Measurable; Measures; Mediating; Medical; Mental Depression; Modeling; Nervous System Physiology; Neurosecretory Systems; Normal Range; Outcome; Pain; Parasympathetic Nervous System; Patients; Pediatrics; Prediction of Response to Therapy; Process; Psychological Stress; Reporting; Research; Rest; Risk; Sampling; Source; Stress; Stress and Coping; Sympathetic Nervous System; Symptoms; Testing; Therapeutic Intervention; Time; Training; Treatment Efficacy; Treatment outcome; Ulcerative Colitis; Vomiting; Work; Youth; anxiety symptoms; biological adaptation to stress; clinical remission; clinically relevant; cognitive enhancement; depressive symptoms; efficacy testing; emotional distress; flexibility; follow-up; gastrointestinal; gut-brain axis; heart rate variability; hypothalamic-pituitary-adrenal axis; improved; indexing; intervention effect; pediatric patients; persistent symptom; primary outcome; programs; psychologic; psychological distress; psychosocial; technology training; treatment program; virtual

PROJECT SUMMARY Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are immune- mediated gastrointestinal disorders associated with chronic medical and psychosocial dysfunction. IBD is increasingly conceptualized as a product of the brain-gut axis, a model that describes the network of communication between the central nervous system (CNS), the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis, and the gut. Consistent with a brain-gut axis model, patients with IBD demonstrate dysfunction of the ANS indicative of a chronic stress response. ANS functioning can be measured via heart rate variability (HRV), a non-invasive measure suitable for pediatrics. Early evidence suggests that patients with IBD exhibit alterations in HRV consistent with ANS rigidity as well as psychological distress and increased emotional reactivity to stress. These alterations in autonomic functioning are also observed in individuals with anxiety and depressive disorders, and it is well recognized that youth with IBD are at increased risk for developing chronic anxiety and depression. Biofeedback training to treat alterations in HRV has led to improvements in disease symptoms as well as reductions in emotional distress for youth with other chronic gastrointestinal illnesses. The goal of the proposed work is to test the utility of HRV as a biomarker of clinical symptoms as well as symptoms of anxiety and depression in pediatric patients with IBD who are enrolled in a biofeedback therapy program. In this R03 project, I will build on the work of my K23 (K23DK122115) to establish HRV as a clinically relevant and modifiable biomarker that can be reliably used in treatment studies of young patients with clinical symptoms of IBD and related stress, depression, and anxiety. I developed and am currently testing a remote HRV biofeedback-enhanced cognitive behavioral therapy (CBT) treatment program in 40 youth with IBD and symptoms of anxiety and depression. With R03 support we will be able to process the rich but complex raw HRV data obtained at baseline, during biofeedback sessions, and at posttest to evaluate the trajectory of HRV in these youth currently in treatment. The overall goals of the current study are to (1) determine the relationship between baseline HRV and clinical symptoms of IBD, anxiety, and depression in 40 adolescents with IBD and (2) determine if HRV changes with a virtual, biofeedback-enhanced CBT treatment intervention. This R03 offers a source of support for a new avenue of inquiry into HRV as a brain-gut axis mechanism driving chronic psychological distress and clinical symptoms in patients with pediatric IBD. Combined with the outcomes of the K23 research, findings will support a competitive R01 to test efficacy of a biofeedback-enhanced CBT intervention, using HRV as a primary outcome variable and biomarker of clinical improvement.

项目概要 炎症性肠病（IBD），包括克罗恩病和溃疡性结肠炎，是一种免疫系统疾病。 与慢性医学和心理社会功能障碍相关的胃肠道疾病是 IBD。 越来越多地被概念化为脑肠轴的产物，脑肠轴是一个描述大脑网络的模型。 中枢神经系统（CNS）、自主神经系统（ANS）、 下丘脑-垂体-肾上腺（HPA）轴和肠道与脑肠轴模型一致，患者患有 IBD 功能障碍表明 ANS 可能存在慢性应激反应。 通过心率变异性 (HRV) 进行测量，这是一种适用于儿科的非侵入性测量方法。 表明 IBD 患者的 HRV 变化与 ANS 僵化以及心理变化一致 痛苦和对压力的情绪反应增加也与自主神经功能的改变有关。 在患有焦虑症和抑郁症的个体中观察到，并且众所周知，患有 IBD 的青少年 进行生物反馈训练来治疗改变的风险增加。 HRV 改善了疾病症状并减少了青少年的情绪困扰 拟议工作的目标是测试 HRV 作为治疗方法的效用。 IBD 儿科患者临床症状以及焦虑和抑郁症状的生物标志物 参加生物反馈治疗计划的人 在这个 R03 项目中，我将以我的 K23 的工作为基础。 (K23DK122115) 将 HRV 建立为临床相关且可修改的生物标志物，可可靠地用于 具有 IBD 临床症状和相关压力、抑郁和焦虑的年轻患者的治疗研究。 开发并目前正在测试远程 HRV 生物反馈增强认知行为疗法 (CBT) 在 R03 的支持下，我们将针对 40 名患有 IBD 以及焦虑和抑郁症状的青少年开展治疗计划。 能够处理在基线、生物反馈期间和在 后测试评估这些目前正在接受治疗的青少年的 HRV 轨迹。 研究的目的是 (1) 确定基线 HRV 与 IBD、焦虑和疾病的临床症状之间的关系 40 名患有 IBD 的青少年患有抑郁症，并且 (2) 确定 HRV 是否随着虚拟的、生物反馈增强的变化而改变 CBT 治疗干预为 HRV 作为一种新的研究途径提供了支持。 脑肠轴机制驱动慢性心理困扰和临床症状 结合 K23 研究的结果，研究结果将支持有竞争力的 R01 进行测试。 使用 HRV 作为主要结果变量的生物反馈增强 CBT 干预的功效，以及 临床改善的生物标志物。