El-Sayed Zeinab A, Mostafa Gehan A, Aly Gamal S, El-Shahed Ghada S, El-Aziz Manal M Abd, El-Emam Safaa M
Department of Paediatrics, Faculty of Medicine, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt.
Rheumatology (Oxford). 2009 Jul;48(7):843-8. doi: 10.1093/rheumatology/kep134. Epub 2009 May 22.
Cardiovascular autonomic neuropathy (CAN) in patients with rheumatic diseases may result in sudden death, possibly from arrhythmia and myocardial infarction due to its frequent association with microvascular disease. Autonomic dysfunction may contribute to initiation and perpetuation of rheumatic diseases. Thus, we aimed to assess cardiovascular autonomic function in lupus and juvenile idiopathic arthritis (JIA) patients.
Assessment of cardiovascular autonomic function was done in 20 lupus and 20 JIA patients, aged 8-16 years, by five non-invasive autonomic function tests (AFTs) and serum levels of neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP), as indicators of sympathetic and parasympathetic functions, respectively, in comparison with 40 matched healthy control subjects.
Clinical evidence of CAN was found in 65 and 40% of lupus and JIA patients, respectively, and in none of healthy controls. Lupus and JIA patients had significantly lower serum NPY and VIP than controls (P < 0.001). The five AFTs score had significant negative correlations to NPY and VIP (P < 0.001). Patients with CAN had significantly lower serum NPY and VIP than patients without (P < 0.001). Clinical evidence of CAN was found in 41.7 and 14.3% of asymptomatic lupus and JIA patients, respectively. There was significant positive association between CAN and important disease manifestations, including activity, in these patients.
CAN is common in lupus and JIA patients, even in absence of relevant symptoms. Thus, assessments of cardiac autonomic function, by AFTs and serum autonomic neuropeptides (NPY and VIP), and the therapeutic effects of NPY and VIP are recommended in these patients.
风湿性疾病患者的心血管自主神经病变（CAN）可能导致猝死，这可能是由于其常与微血管疾病相关，进而引发心律失常和心肌梗死。自主神经功能障碍可能促使风湿性疾病的发生和持续发展。因此，我们旨在评估狼疮和幼年特发性关节炎（JIA）患者的心血管自主神经功能。
对20例年龄在8至16岁的狼疮患者和20例JIA患者进行心血管自主神经功能评估，采用五项非侵入性自主神经功能测试（AFTs），并检测血清神经肽Y（NPY）和血管活性肠肽（VIP）水平，分别作为交感神经和副交感神经功能的指标，同时与40例匹配的健康对照者进行比较。
分别在65%的狼疮患者和40%的JIA患者中发现CAN的临床证据，而健康对照者中均未发现。狼疮和JIA患者的血清NPY和VIP水平显著低于对照组（P<0.001）。五项AFTs评分与NPY和VIP呈显著负相关（P<0.001）。患有CAN的患者血清NPY和VIP水平显著低于未患CAN的患者（P<0.001）。分别在41.7%的无症状狼疮患者和14.3%的无症状JIA患者中发现CAN的临床证据。在这些患者中，CAN与包括疾病活动度在内的重要疾病表现之间存在显著正相关。
CAN在狼疮和JIA患者中很常见，即使在没有相关症状的情况下也是如此。因此，建议对这些患者进行AFTs和血清自主神经肽（NPY和VIP）评估心脏自主神经功能，以及评估NPY和VIP的治疗效果。
