Barendregt P J, van Den Meiracker A H, Markusse H M, Tulen J H, Boomsma F, van Der Heijde G L, Veld A J
Department of Rheumatology, Zuiderziekenhuis, Rotterdam, the Netherlands.
Ann Rheum Dis. 1999 Dec;58(12):746-50. doi: 10.1136/ard.58.12.746.
To investigate the sympathetic and parasympathetic cardiovascular function in primary Sjögren's syndrome (SS) and to investigate the possible relation with ocular dryness.
41 (40 women) patients with primary SS, mean age 50 years (range 20-80) with a mean disease duration of eight years (range 1-30), were studied. In each patient direct arterial blood pressure (BP), heart rate (HR) and respiration were measured continuously for two hours. The function of the autonomic circulatory regulation was evaluated by measuring the heart rate response to deep breathing (6 cycles/min) and by means of the Valsalva manoeuvre and the responses of BP, HR and plasma noradrenaline (norepinephrine) concentrations to a 10 minute 60 degree head up tilt test. Pupillography was done to evaluate ocular autonomic function.
The HR-Valsalva ratio was abnormal in 24% of the patients, and the HR variability during forced respiration was abnormal in 56% of the patients. The HR responses to both the Valsalva manoeuvre and deep breathing, as indicators of parasympathetic function, were abnormally low in 6 of 41 (15%) patients. In only two patients the decrease in systolic BP in response to the head up tilt test, as indicator of sympathetic function, was more than 20 mm Hg. However, increment of plasma noradrenaline concentration during head up tilt test and the overshoot of BP in phase IV of the Valsalva manoeuvre, as indicators of sympathetic function, were normal in both patients. Thus, no evidence for sympathetic dysfunction was found, whereas evidence for parasympathetic failure occurred sometimes. Autonomic pupillary function in patients with primary SS and healthy controls, as well as the Schirmer test in patients with or without evidence for parasympathetic dysfunction as based on the results of the Valsalva and deep breathing tests, were not significantly different.
Parasympathetic, but not sympathetic dysfunction seems to occur in a subgroup of primary SS. Results show that this does not necessarily contribute to the typical ocular dryness in this condition.
研究原发性干燥综合征（SS）患者的交感和副交感心血管功能，并探讨其与眼干的可能关系。
对41例（40例女性）原发性SS患者进行研究，平均年龄50岁（范围20 - 80岁），平均病程8年（范围1 - 30年）。对每位患者连续两小时测量直接动脉血压（BP）、心率（HR）和呼吸。通过测量深呼吸（6次/分钟）时的心率反应、瓦尔萨尔瓦动作以及10分钟60度头高位倾斜试验中BP、HR和血浆去甲肾上腺素浓度的反应来评估自主循环调节功能。进行瞳孔描记术以评估眼部自主神经功能。
24%的患者HR - 瓦尔萨尔瓦比值异常，56%的患者强迫呼吸时的HR变异性异常。作为副交感神经功能指标，41例患者中有6例（15%）对瓦尔萨尔瓦动作和深呼吸的HR反应异常低。作为交感神经功能指标，仅2例患者头高位倾斜试验时收缩压下降超过20 mmHg。然而，头高位倾斜试验期间血浆去甲肾上腺素浓度的升高以及瓦尔萨尔瓦动作IV期的血压过冲，作为交感神经功能指标，在这两名患者中均正常。因此，未发现交感神经功能障碍的证据，而有时会出现副交感神经功能衰竭的证据。原发性SS患者和健康对照者的自主瞳孔功能，以及根据瓦尔萨尔瓦和深呼吸试验结果有或无副交感神经功能障碍证据的患者的泪液分泌试验，均无显著差异。
原发性SS的一个亚组似乎存在副交感神经功能障碍，而非交感神经功能障碍。结果表明，这不一定导致该疾病典型的眼干症状。
