Chelimsky Thomas C, Chelimsky Gisela G
Department of Neurology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
J Pediatr Gastroenterol Nutr. 2007 Mar;44(3):326-30. doi: 10.1097/MPG.0b013e31802bddb7.
Although cyclic vomiting syndrome (CVS) is associated with migraine, and migraine in turn is associated with orthostatic tachycardia, few studies have explored the association of CVS and autonomic dysfunction. We describe the results of autonomic testing in 6 children with characteristic CVS.
All patients fully met the established criteria for the diagnosis of CVS, were well hydrated, and were beyond their episode of vomiting. We performed 3 tests of cardiovascular function and 1 sudomotor test, using standard previously published methods.
The findings were surprisingly uniform, with normal cardiovascular responses to deep breathing and to the Valsalva maneuver in all patients, a significant increase in heart rate (>30 beats per minute) with tilt testing, and a vasodepressor tendency in 2 patients. Interestingly, abdominal pain occurred at blood pressure nadir in both these patients and in a third patient without the vasodepressor findings but who described syncope clinically. Sudomotor test results were abnormal in all 6 patients, with reduced responses in 5 of 6 and exaggerated responses in the 6th. All 6 patients reported a personal or family history of migraine headaches.
CVS is associated with remarkably uniform primarily sympathetic autonomic dysfunction, affecting mainly the vasomotor and sudomotor systems, and compatible with an underlying autonomic neuropathy. The occurrence of symptoms during tilt testing in half the patients suggests that these findings may play a true pathophysiologic role. A vagally modulated sympathetic effect is postulated as the best mechanistic model to account for all current physiologic data on cyclic vomiting and gastroparesis.
尽管周期性呕吐综合征（CVS）与偏头痛相关，而偏头痛又与体位性心动过速相关，但很少有研究探讨CVS与自主神经功能障碍之间的关联。我们描述了6例典型CVS患儿的自主神经测试结果。
所有患者均完全符合既定的CVS诊断标准，水分充足，且已度过呕吐期。我们采用先前发表的标准方法进行了3项心血管功能测试和1项汗腺运动功能测试。
结果惊人地一致，所有患者对深呼吸和瓦尔萨尔瓦动作的心血管反应均正常，倾斜试验时心率显著增加（>30次/分钟），2例患者有血管减压倾向。有趣的是，这2例患者以及第3例无血管减压表现但临床上描述有晕厥的患者，在血压最低点时均出现腹痛。所有6例患者的汗腺运动功能测试结果均异常，6例中有5例反应减弱，1例反应增强。所有6例患者均有偏头痛个人史或家族史。
CVS与主要为交感神经的自主神经功能障碍显著相关，主要影响血管运动和汗腺运动系统，符合潜在的自主神经病变。半数患者在倾斜试验期间出现症状，提示这些发现可能具有真正的病理生理作用。假定迷走神经调节的交感神经效应是解释目前关于周期性呕吐和胃轻瘫的所有生理数据的最佳机制模型。
