Haapaniemi T H, Pursiainen V, Korpelainen J T, Huikuri H V, Sotaniemi K A, Myllylä V V
Department of Neurology, University of Oulu, PO Box 5000, 90014 University of Oulu, Finland.
J Neurol Neurosurg Psychiatry. 2001 Mar;70(3):305-10. doi: 10.1136/jnnp.70.3.305.
Cardiovascular reflex tests have shown both sympathetic and parasympathetic failure in Parkinson's disease. These tests, however, describe the autonomic responses during a restricted time period and have great individual variability, providing a limited view of the autonomic cardiac control mechanisms. Thus, they do not reflect tonic autonomic regulation. The aim was to examine tonic autonomic cardiovascular regulation in untreated patients with Parkinson's disease.
24 Hour ambulatory ECG was recorded in 54 untreated patients with Parkinson's disease and 47 age matched healthy subjects. In addition to the traditional spectral (very low frequency, VLF; low frequency, LF; high frequency, HF) and non-spectral components of heart rate variability, instantaneous beat to beat variability (SD1) and long term continuous variability (SD2) derived from Poincaré plots, and the slope of the power law relation were analysed.
All spectral components (p<0.01) and the slope of the power-law relation (p<0.01) were lower in the patients with Parkinson's disease than in the control subjects. The Unified Parkinson's disease rating scale total and motor scores had a negative correlation with VLF and LF power spectrum values and the power law relation slopes. Patients with mild hypokinesia had higher HF values than patients with more severe hypokinesia. Tremor and rigidity were not associated with the HR variability parameters.
Parkinson's disease causes dysfunction of the diurnal autonomic cardiovascular regulation as demonstrated by the spectral measures of heart rate variability and the slope of the power law relation. This dysfunction seems to be more profound in patients with more severe Parkinson's disease.
心血管反射测试显示帕金森病患者存在交感神经和副交感神经功能障碍。然而，这些测试描述的是特定时间段内的自主神经反应，且个体差异很大，对自主神经心脏控制机制的了解有限。因此，它们无法反映自主性紧张性调节。本研究旨在探讨未经治疗的帕金森病患者的自主性紧张性心血管调节情况。
对54例未经治疗的帕金森病患者和47例年龄匹配的健康受试者进行24小时动态心电图记录。除了传统的心率变异性频谱成分（极低频，VLF；低频，LF；高频，HF）和非频谱成分外，还分析了来自庞加莱图的逐搏瞬时变异性（SD1）和长期连续变异性（SD2），以及幂律关系的斜率。
帕金森病患者的所有频谱成分（p<0.01）和幂律关系的斜率（p<0.01）均低于对照组。帕金森病统一评分量表总分和运动评分与VLF和LF功率谱值以及幂律关系斜率呈负相关。轻度运动迟缓患者的HF值高于重度运动迟缓患者。震颤和强直与心率变异性参数无关。
帕金森病导致昼夜自主性心血管调节功能障碍，这通过心率变异性的频谱测量和幂律关系的斜率得以证实。这种功能障碍在帕金森病病情较重的患者中似乎更为明显。
