Stojanovich L, Milovanovich B, de Luka S R, Popovich-Kuzmanovich D, Bisenich V, Djukanovich B, Randjelovich T, Krotin M
Bezhanijska Kosa University Medical Center, Belgrade, Serbia.
Lupus. 2007;16(3):181-5. doi: 10.1177/0961203306076223.
Neurological manifestations are known to occur in patients with autoimmune diseases, often subclinically, but autonomic nervous system (ANS) involvement has rarely been studied, and studies have shown conflicting results. We performed cardiovascular ANS assessment in 125 patients with autoimmune diseases in this case-control study, including 54 patients with systemic lupus erythematosus (SLE), 39 with rheumatoid arthritis (RA), 20 with primary Sjbgren syndrome (pSS), eight patients with polymyalgia rheumatica (PR), four patients with scleroderma (Ssc) and 35 healthy control subjects. The control group was formed to approximately match the mean age of SLE, RA and pSS patients; controls did not differ significantly by gender from the autoimmune pations. All patients with were in stable condition. Autonomic nervous system dysfunction was diagnosed by applying cardiovascular reflex tests according to Ewing, and was considered to exist if at least two tests were positive. Vagal dysfunction was established by applying three tests: Valsalva manoeuvre, deep breathing test, and heart rate response to standing. Sympathetic dysfunction was examined by applying two tests: blood pressure response to standing and handgrip test. In all cardiovascular reflex tests, frequencies of abnormal results were significantly higher among the patients than among the controls (P < 0.05). The difference between the autoimmune patients and the controls was particularly significant in sympathetic and parasympathetic tests, with P < 0.0001. No correlation was found between disease duration, clinical manifestations, cardiovascular risk factors and diseases activity on the one hand, and ANS dysfunction on the other hand. Cardiovascular autonomic dysfunction was revealed in the majority of autoimmune patients.
已知自身免疫性疾病患者会出现神经学表现，通常为亚临床症状，但自主神经系统（ANS）受累情况鲜有研究，且各项研究结果相互矛盾。在这项病例对照研究中，我们对125例自身免疫性疾病患者进行了心血管自主神经系统评估，其中包括54例系统性红斑狼疮（SLE）患者、39例类风湿关节炎（RA）患者、20例原发性干燥综合征（pSS）患者、8例风湿性多肌痛（PR）患者、4例硬皮病（Ssc）患者以及35名健康对照者。对照组的年龄均值与SLE、RA和pSS患者大致匹配；对照组在性别上与自身免疫性疾病患者无显著差异。所有患者病情均稳定。根据尤因（Ewing）方法应用心血管反射试验诊断自主神经系统功能障碍，若至少两项试验呈阳性则认为存在自主神经系统功能障碍。通过应用三项试验确定迷走神经功能障碍：瓦尔萨尔瓦动作（Valsalva maneuver）、深呼吸试验以及站立时的心率反应。通过应用两项试验检查交感神经功能障碍：站立时的血压反应和握力试验。在所有心血管反射试验中，患者异常结果的发生率显著高于对照组（P < 0.05）。自身免疫性疾病患者与对照组之间在交感神经和副交感神经试验中的差异尤为显著，P < 0.0001。一方面，疾病持续时间、临床表现、心血管危险因素和疾病活动度与另一方面的自主神经系统功能障碍之间未发现相关性。大多数自身免疫性疾病患者存在心血管自主神经功能障碍。
