Kovács L, Papós M, Takács R, Róka R, Csenke Z, Kovács A, Várkonyi T, Pajor L, Pávics L, Pokorny G
Department of Rheumatology, University of Szeged, Faculty of Medicine, Szeged.
Clin Exp Rheumatol. 2003 Nov-Dec;21(6):697-703.
Antibodies reacting with the m3 subtype muscarinic acetylcholine receptor appear to be an important pathogenic factor in primary Sjögren's syndrome (pSS). As this receptor subtype is functionally important in the gastrointestinal and urinary tracts, and very little is known about the autonomic nervous system function in these organs in pSS patients, the occurrence and clinical significance of an autonomic nervous system dysfunction involving the gastrointestinal and urinary tracts were investigated.
Data on clinical symptoms attributable to an autonomic dysfunction were collected from 51 pSS patients. Gastric emptying scintigraphy and urodynamic studies were performed on 30 and 16 patients, respectively, and the results were correlated with patient characteristics and with the presence of autonomic nervous system symptoms.
Gastric emptying was abnormally slow in 21 of the 30 examined patients (70%). Urodynamic findings, compatible with a decreased detrusor muscle tone or contractility were found in 9 of the 16 patients tested (56%). Various symptoms of an autonomic nervous system dysfunction were reported by 2-16% of the patients.
Signs of an autonomic nervous system dysfunction involving the gastrointestinal and the urinary systems can be observed in the majority of pSS patients. This high occurrence is rarely associated with clinically significant symptoms. The authors presume a role of autoantibodies reacting with the m3 muscarinic acetylcholine receptor in the elicitation of the autonomic dysfunction.
与毒蕈碱型乙酰胆碱受体m3亚型发生反应的抗体似乎是原发性干燥综合征（pSS）的一个重要致病因素。由于该受体亚型在胃肠道和泌尿系统中具有重要功能，而对于pSS患者这些器官的自主神经系统功能知之甚少，因此对涉及胃肠道和泌尿系统的自主神经系统功能障碍的发生情况及其临床意义进行了研究。
收集了51例pSS患者中归因于自主神经功能障碍的临床症状数据。分别对30例和16例患者进行了胃排空闪烁扫描和尿动力学研究，并将结果与患者特征以及自主神经系统症状的存在情况进行了关联分析。
在30例接受检查的患者中，有21例（70%）胃排空异常缓慢。在16例接受测试的患者中，有9例（56%）的尿动力学检查结果显示逼尿肌张力或收缩力下降。2%至16%的患者报告了各种自主神经系统功能障碍症状。
在大多数pSS患者中可观察到涉及胃肠道和泌尿系统的自主神经系统功能障碍迹象。这种高发生率很少与具有临床意义的症状相关。作者推测与毒蕈碱型乙酰胆碱受体m3亚型发生反应的自身抗体在自主神经功能障碍的引发中起作用。
