Haley Robert W, Vongpatanasin Wanpen, Wolfe Gil I, Bryan Wilson W, Armitage Roseanne, Hoffmann Robert F, Petty Frederick, Callahan Timothy S, Charuvastra Elizabeth, Shell William E, Marshall W Wesley, Victor Ronald G
Divisions of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8874, USA.
Am J Med. 2004 Oct 1;117(7):469-78. doi: 10.1016/j.amjmed.2004.03.041.
To test the hypothesis that subtle abnormalities of the autonomic nervous system underlie the chronic symptoms reported by many Gulf War veterans, such as chronic diarrhea, dizziness, fatigue, and sexual dysfunction.
Twenty-two ill Gulf War veterans and 19 age-, sex-, and education-matched control veterans underwent measurement of circadian rhythm of heart rate variability by 24-hour electrocardiography, ambulatory blood pressure recording, Valsalva ratio testing, sympathetic skin response evaluation, sweat imprint testing, and polysomnography. Investigators were blinded to case- or control-group status.
High-frequency spectral power of heart rate variability increased normally 2.2-fold during sleep in controls but only 1.2-fold in ill veterans (P <0.0001). In ill veterans as compared with controls, it was lower at night (P = 0.0006), higher during the morning (P = 0.007), but no different during the rest of the day (P = 0.8). The mean heart rate of ill veterans also declined less at night (P = 0.0002), and their corrected QT intervals tended to be longer over the full 24 hours (P = 0.07), particularly at night (P = 0.03). Blunting of the nocturnal heart rate dip in ill veterans was confirmed by 24-hour automatic ambulatory blood pressure monitoring (P = 0.05) and polysomnography (P = 0.03). These differences remained significant after adjusting for potential confounders. Cases and controls were similar on measures of sympathetic adrenergic and sudomotor function, sleep architecture, respiratory function, and circadian variation in blood pressure and body temperature.
Some symptoms of Gulf War syndrome may be due to subtle autonomic nervous system dysfunction.
检验以下假设，即自主神经系统的细微异常是许多海湾战争退伍军人所报告的慢性症状（如慢性腹泻、头晕、疲劳和性功能障碍）的潜在原因。
22名患病的海湾战争退伍军人以及19名年龄、性别和教育程度相匹配的对照退伍军人接受了以下检查：通过24小时心电图测量心率变异性的昼夜节律、动态血压记录、瓦尔萨尔瓦比率测试、交感神经皮肤反应评估、汗印测试和多导睡眠图。研究人员对病例组或对照组状态不知情。
对照组中，心率变异性的高频谱功率在睡眠期间正常增加2.2倍，而患病退伍军人仅增加1.2倍（P<0.0001）。与对照组相比，患病退伍军人夜间该指标较低（P = 0.0006），早晨较高（P = 0.007），但在一天中的其他时间无差异（P = 0.8）。患病退伍军人的平均心率在夜间下降也较少（P = 0.0002），并且他们校正后的QT间期在整个24小时内往往更长（P = 0.07），尤其是在夜间（P = 0.03）。通过24小时自动动态血压监测（P = 0.05）和多导睡眠图（P = 0.03）证实了患病退伍军人夜间心率下降的减弱。在调整潜在混杂因素后，这些差异仍然显著。病例组和对照组在交感肾上腺素能和汗腺运动功能、睡眠结构、呼吸功能以及血压和体温的昼夜变化指标方面相似。
海湾战争综合征的一些症状可能归因于自主神经系统的细微功能障碍。
