Schulze J, Troeger C
Abteilung Hand- und periphere Nervenchirurgie, Universitätsspital Basel, Schweiz.
Handchir Mikrochir Plast Chir. 2010 Feb;42(1):44-8. doi: 10.1055/s-0030-1247590. Epub 2010 Mar 4.
The complex regional pain syndrome type I (CRPS I) is a painful neuropathic disorder with an antecedent disproportionate trauma leading to spontaneous pain, hyperalgesia, impaired motor function, swelling, changes in sweating and vascular abnormalities without nerve injury. Whether this syndrome is the result of central or peripheral autonomic dysfunction is still a matter of debate. The purpose of this study was to determine the activity of the sympathetic nervous system in patients with CRPS I by power spectral analysis of heart rate variability.
This is a pilot study on 6 patients (mean age 50 years; 4 female, 2 male) diagnosed as suffering from CRPS I and 6 age-matched healthy controls. In the pain-free interval and after taking rest for 5 min, 512 subsequent heart beats were obtained with an ECG standard lead II in the supine and then sitting position. Using an autoregressive model, power spectral densities were calculated for the following frequency bands: <0.040 Hz (very low frequency; VLF), 0.040-0.150 Hz (low frequency; LF) and 0.150-0.4 Hz (high frequency; HF). The sympatho-vagal balance is expressed by the ratio of the low-frequency component (LF) to the high-frequency component (HF) of the power spectrum.
Significant differences in the mean LF/HF ratios were found in the patients with CRPS I compared to the healthy controls in the supine position (LF/HF=4.01 vs. LF/HF=1.27; p=0.041). The application of stress by changing to the sitting position even increased that difference (6.72 vs. 1.93).
Our results support the hypothesis that the pathogenesis of the early stage CRPS I might be related to an increased sympathetic activity. By assessing the autonomic influence on the heart rate variability in CRPS I patients we could also conclude that this disturbance occurs rather at a central level.
Ⅰ型复杂性区域疼痛综合征（CRPS Ⅰ）是一种疼痛性神经病变疾病，先前存在不成比例的创伤，导致自发痛、痛觉过敏、运动功能受损、肿胀、出汗改变和血管异常，且无神经损伤。该综合征是中枢或外周自主神经功能障碍的结果仍存在争议。本研究的目的是通过心率变异性的功率谱分析来确定CRPS Ⅰ患者交感神经系统的活动。
这是一项针对6例诊断为CRPS Ⅰ的患者（平均年龄50岁；4例女性，2例男性）和6例年龄匹配的健康对照者的初步研究。在无痛间期且休息5分钟后，使用心电图标准Ⅱ导联在仰卧位然后坐位获取随后的512次心跳。使用自回归模型，计算以下频段的功率谱密度：<0.040 Hz（极低频；VLF）、0.040 - 0.150 Hz（低频；LF）和0.150 - 0.4 Hz（高频；HF）。交感 - 迷走平衡用功率谱的低频成分（LF）与高频成分（HF）的比值表示。
与健康对照者相比，CRPS Ⅰ患者在仰卧位时平均LF/HF比值存在显著差异（LF/HF = 4.01 vs. LF/HF = 1.27；p = 0.041）。改为坐位施加压力后，这种差异甚至更大（6.72 vs. 1.93）。
我们的结果支持以下假设，即早期CRPS Ⅰ的发病机制可能与交感神经活动增加有关。通过评估自主神经对CRPS Ⅰ患者心率变异性的影响，我们还可以得出这种紊乱主要发生在中枢水平的结论。
