Lucini D, Cerchiello M, Basilisco G, Cainelli M, Bianchi P A, Fiorelli G, Malliani A, Pagani M
Centro Ricerca sulla Terapia Neurovegetativa, Medicina Interna I, Ospedale L. Sacco, CNR, Università di Milano, Italy.
Auton Neurosci. 2000 Nov 1;84(3):122-9. doi: 10.1016/S1566-0702(00)00199-5.
Beyond the fundamental pathogenetic importance of Helicobacter Pylori a possible additional role of vagal innervation in favouring or modulating the clinical history of duodenal ulcer (DU) has been suggested by old studies employing invasive methodologies. Aim of this study was to assess whether vagal prevalence in autonomic modulation was present in healed DU patients (n=20) as compared to controls,(n=50), using a validated non-invasive methodology, based on spectral analysis of cardiovascular variability. This approach provides markers of the sympathetic and vagal modulations of the SA node, respectively by way of the normalized low frequency (LF(RR)) and high frequency (HF(RR)) components of RR interval variability; LF/HF ratio furnishes a marker of sympatho-vagal balance. In addition, sham feeding (SF) provided a means to assess, in DU patients, neurally mediated acid secretion, as the SF acid output (SAO) to basal acid output (BAO) ratio (SAO/BAO). Results showed that LF(RR) was smaller in DU patients than in controls (40.3+/-3.9 vs. 52.3+/-2.3 normalized units, nu; P<0.05). On the contrary, HF(RR) was greater (52.1+/-3.7 vs. 35.7+/-2.3 nu; P<0.05). Conversely the LF component of SAP variability, a marker of sympathetic vasomotor modulations, and the index alpha, a measure of baroreflex control of the SA node, as well as respiratory patterns, were similar in the two groups. SAO/BAO ratio was significantly correlated with markers of autonomic control of the SA node (r = -0.67, P<0.0083 with HF(RR)). In conclusion results suggest an enhanced vagal modulation of heart period in DU patients at rest, that appears linked to indices of neurally mediated gastric acid secretion response.
除幽门螺杆菌的基本致病重要性外，早期采用侵入性方法的研究表明，迷走神经支配在十二指肠溃疡（DU）临床病程的促进或调节中可能具有额外作用。本研究的目的是使用一种基于心血管变异性频谱分析的经过验证的非侵入性方法，评估与对照组（n = 50）相比，愈合的DU患者（n = 20）在自主神经调节中是否存在迷走神经优势。这种方法分别通过RR间期变异性的标准化低频（LF（RR））和高频（HF（RR））成分提供窦房结交感神经和迷走神经调节的标志物；LF/HF比值提供交感-迷走神经平衡的标志物。此外，假饲（SF）为评估DU患者神经介导的胃酸分泌提供了一种手段，即SF酸输出（SAO）与基础酸输出（BAO）的比值（SAO/BAO）。结果显示，DU患者的LF（RR）低于对照组（40.3±3.9对52.3±2.3标准化单位，nu；P<0.05）。相反，HF（RR）更高（52.1±3.7对3±2.3 nu；P<0.05）。相反，两组的交感神经血管运动调节标志物SAP变异性的LF成分、窦房结压力反射控制指标α以及呼吸模式相似。SAO/BAO比值与窦房结自主控制标志物显著相关（与HF（RR）的r = -0.67，P<0.0083）。总之，结果表明DU患者静息时心脏周期的迷走神经调节增强，这似乎与神经介导的胃酸分泌反应指标有关。
