Shinoura Nobusada, Yamada Ryozi
Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
Clin Neurophysiol. 2005 Jun;116(6):1286-90. doi: 10.1016/j.clinph.2005.02.005. Epub 2005 Mar 26.
Autonomic nerve dysregulation produces a sense of impaired well-being and interferes with work performance in affected individuals. In this study, we characterized the pathophysiology of this condition.
Six patients with high symptom scores for orthostatic intolerance (OI) along with age- and sex-matched normal volunteers were directed to perform a head-down manoeuvre, and the change in cerebral blood flow (CBF) and cerebral oxygen levels (rSO(2)) in the right and left frontal lobes was measured using near-infrared spectroscopy (NIRS).
The head-down manoeuvre induced a much greater increase in right-sided total haemoglobin concentration (THbl) in normal volunteers (0.51+/-0.24) when compared to symptomatic patients (0.0+/-0.04) but had no effect on left-sided THbl (P<0.05) in either group. Five of 6 patients showed a gradual decrease in right-sided THbl when assuming a sitting position, and all patients with this pattern complained of symptoms of multiple autonomic dysfunction. Further, this pattern of changes in right-sided THbl was not observed in normal volunteers.
The gradual decrease of THbl with the sitting position and the lack of increase during the head-down manoeuvre in symptomatic patients suggest that these patients have impaired vasoreactivity in the right frontal lobes.
This impaired vasoreactivity likely reflects dysfunction of the right hemisphere and the sympathetic nervous system in patients with OI.
自主神经调节异常会使患者产生幸福感受损的感觉，并干扰其工作表现。在本研究中，我们对这种情况的病理生理学进行了特征描述。
选取6例直立不耐受（OI）症状评分较高的患者以及年龄和性别匹配的正常志愿者，指导他们进行头低位动作，使用近红外光谱（NIRS）测量左右额叶的脑血流量（CBF）和脑氧水平（rSO₂）变化。
与有症状的患者（0.0±0.04）相比，头低位动作使正常志愿者右侧总血红蛋白浓度（THbl）升高幅度更大（0.51±0.24），但两组中该动作对左侧THbl均无影响（P<0.05）。6例患者中有5例在坐位时右侧THbl逐渐降低，所有有这种模式的患者均主诉有多种自主神经功能障碍症状。此外，正常志愿者未观察到右侧THbl的这种变化模式。
有症状患者坐位时THbl逐渐降低以及头低位动作时未升高，提示这些患者右侧额叶的血管反应性受损。
这种血管反应性受损可能反映了OI患者右半球和交感神经系统的功能障碍。
