Koszewicz M, Gosk-Bierska I, Bilińska M, Podemski R, Budrewicz S, Adamiec R, Słotwiński K
Department of Neurology, Medical University of Wrocław, Wrocław, Poland.
Int Angiol. 2009 Apr;28(2):127-31.
The pathogenesis of Raynaud's phenomenon is still unclear. Neural and intravascular mechanisms are thought to be involved in the pathological process. The role of the autonomic nervous system is continually discussed, with particular attention to over-reactivity of the sympathetic part. The aim of this study was the clinical and electrophysiological analysis of autonomic nervous system function in patients with primary Raynaud's phenomenon.
Thirty four patients with primary Raynaud's phenomenon and 31 sex and age-matched controls were examined. Neurological examination, modified Low's Questionnaire, orthostatic and sustained handgrip tests, conduction velocity study in three nerves, sympathetic skin response (SSR), and heart rate variability (HRV) during deep breathing and at rest with the fast Fourier transform were performed.
In the clinical examinations, 35.3% of the primary Raynaud's patients presented sensory neuropathy, but this was not confirmed in the standard conduction velocity tests. The modified Low's Questionnaire revealed dysautonomy in 82% of the patients. Autonomic regulation during the orthostatic and handgrip tests were within the normal limits. HRV at rest and the E/I ratio were significantly lower in the patient group than in the controls, while HRV spectrum analysis revealed the predominance of the low-frequency band in the patients.
These results indicate the presence of sympathetic dysregulation and impairment of parasympathetic modulation of heart function in primary Raynaud's patients. The different cardiovascular and sudomotor functions are not affected to the same degree. These observations might support the theory of a central impairment of autonomic function in primary Raynaud's phenomenon. Peripheral nerve lesion as a coexisting cause of the observed dysautonomy remains uncertain.
雷诺现象的发病机制仍不清楚。神经和血管内机制被认为参与了病理过程。自主神经系统的作用一直存在争议，尤其关注交感神经部分的过度反应。本研究的目的是对原发性雷诺现象患者的自主神经系统功能进行临床和电生理分析。
对34例原发性雷诺现象患者和31例性别及年龄匹配的对照者进行检查。进行了神经学检查、改良的洛氏问卷、直立和持续握力试验、三条神经的传导速度研究、交感皮肤反应（SSR）以及深呼吸和静息时的心率变异性（HRV）快速傅里叶变换分析。
在临床检查中，35.3%的原发性雷诺患者存在感觉神经病变，但在标准传导速度测试中未得到证实。改良的洛氏问卷显示82%的患者存在自主神经功能障碍。直立和握力试验期间的自主调节在正常范围内。患者组静息时的HRV和E/I比值显著低于对照组，而HRV频谱分析显示患者低频带占优势。
这些结果表明原发性雷诺患者存在交感神经调节异常和副交感神经对心脏功能调节受损。不同的心血管和汗腺运动功能受到的影响程度不同。这些观察结果可能支持原发性雷诺现象中自主神经功能中枢受损的理论。作为观察到的自主神经功能障碍并存原因的周围神经病变仍不确定。
