Vita G, Bellinghieri G, Trusso A, Costantino G, Santoro D, Monteleone F, Messina C, Savica V
Institute of Nephrological and Neurological Sciences and Division of Nephrology, University of Messina, Italy.
Kidney Int. 1999 Jul;56(1):232-7. doi: 10.1046/j.1523-1755.1999.00511.x.
There is good evidence that power spectral analysis (PSA) of heart rate variability may provide an insight into the understanding of autonomic disorders.
We investigated 30 chronic uremic patients who were on periodic bicarbonate hemodialysis by a battery of six cardiovascular autonomic tests (beat-to-beat variations during quiet breathing and deep breathing, heart rate responses to the Valsalva maneuver and standing, blood pressure responses to standing and sustained handgrip) and PSA of heart rate variations.
Eleven patients (37%) had an abnormal response to only one parasympathetic test. Twelve patients (40%) had a definite parasympathetic damage, as indicated by at least two abnormal heart rate tests, whereas four (13%) had combined parasympathetic and sympathetic damage. Multivariate analysis of the cardiovascular tests revealed that 19 patients (63%) had moderate-to-severe autonomic neuropathy (AN), and 11 patients exhibited normal autonomic function. Among the symptoms suggestive of autonomic dysfunction, only impotence in males was significantly associated with test-proven AN. The PSA of the heart rate variability demonstrated a good discrimination of low-frequency (LF) and high-frequency (HF) bands (LF, 0.03 to 0.15 Hz; HF, 0.15 to 0.33 Hz) among controls, uremic patients without test-proven AN, and uremic patients with test-proven AN. A significant reduction of the LF value on supine uremic patients without AN suggests that an early sympathetic involvement exists that traditional autonomic tests were unable to detect.
Our study indicates that the current opinion of a major parasympathetic damage in chronic uremic patients on hemodialysis has to be modified in favor of a more widespread autonomic dysfunction involving both the sympathetic and parasympathetic pathways.
有充分证据表明，心率变异性的功率谱分析（PSA）有助于深入了解自主神经功能紊乱。
我们通过一系列六项心血管自主神经测试（安静呼吸和深呼吸时的逐搏变化、对瓦尔萨尔瓦动作和站立的心率反应、对站立和持续握力的血压反应）以及心率变异性的PSA，对30例接受周期性碳酸氢盐血液透析的慢性尿毒症患者进行了研究。
11例患者（37%）仅对一项副交感神经测试有异常反应。12例患者（40%）存在明确的副交感神经损伤，至少两项心率测试异常表明了这一点，而4例患者（13%）存在副交感神经和交感神经联合损伤。心血管测试的多变量分析显示，19例患者（63%）有中度至重度自主神经病变（AN），11例患者自主神经功能正常。在提示自主神经功能障碍的症状中，只有男性阳痿与经测试证实的AN显著相关。心率变异性的PSA在对照组、经测试未证实有AN的尿毒症患者和经测试证实有AN的尿毒症患者中，对低频（LF）和高频（HF）波段（LF，0.03至0.15赫兹；HF，0.15至0.33赫兹）有良好的区分能力。无AN的仰卧位尿毒症患者LF值显著降低，这表明存在早期交感神经受累，而传统的自主神经测试无法检测到。
我们的研究表明，目前关于血液透析慢性尿毒症患者主要存在副交感神经损伤的观点必须修正，转而支持一种更广泛的自主神经功能障碍，涉及交感神经和副交感神经通路。
