Milovanović Branislav, Stojanović Ljudmila, Milićevik Nebojsa, Vasić Karin, Bjelaković Bojko, Krotin Mirjana
Neurocardiology Laboratory, Department of Cardiology, Clinical Hospital Centre Beianijska kosa, Belgrade, Serbia.
Srp Arh Celok Lek. 2010 Jan-Feb;138(1-2):26-32. doi: 10.2298/sarh1002026m.
The manifestations of autonomic nervous system (ANS) dysfunction in autoimmune diseases have been the subject of many studies. However, the published results pertaining to such research are controversial. Sudden cardiac death due to fatal arrhythmias is frequent in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
To analyse risk predictors of sudden cardiac death related to the degree of autonomic dysfunction.
We performed cardiovascular ANS assessment in 90 patients in this case-controlled study, including 52 (6 male, 46 female) patients with SLE, 38 (6 male, 32 female) with RA and 41 (23 male, 17 female) healthy subjects. The methodology included a comprehensive ECG analysis (with Schiller software AT-10) of QTc interval, late potentials, short-term heart rate variability (HRV) and nonlinear HRV (Poincare plot) analysis; 24-hour Holter ECG monitoring with ECG QTc interval analysis, HRV analysis; 24-hour blood pressure monitoring with systolic and diastolic blood pressure variability; cardiovascular autonomic reflex tests (according to Ewing). Vagal dysfunction was established by performing 3 tests: Valsalva maneuver, deep breathing test and heart rate response to standing test. Dysfunction of the sympathetic nervous system was examined by applying 2 tests: blood pressure response to standing and handgrip test.
In all cardiovascular reflex tests, the frequencies of abnormal results were significantly higher among the patients than among the healthy subjects. Severe autonomic dysfunction was more common in RA. QTc interval was more prolonged in patients with SLE. Both diseases were associated with depressed heart rate variability compared to controls, the reduction being greater in RA patients. In the patients with SLE, autonomic dysfunction is predominantly with higher sympathetic activity while in RA vagal predominance is evident.
SLE and RA are associated with severe autonomic dysfunction and the presence of significant risk predictors related to the onset of sudden cardiac death.
自身免疫性疾病中自主神经系统（ANS）功能障碍的表现一直是众多研究的主题。然而，此类研究已发表的结果存在争议。系统性红斑狼疮（SLE）和类风湿关节炎（RA）患者中因致命性心律失常导致的心脏性猝死很常见。
分析与自主神经功能障碍程度相关的心脏性猝死风险预测因素。
在这项病例对照研究中，我们对90名患者进行了心血管ANS评估，其中包括52名（6名男性，46名女性）SLE患者、38名（6名男性，32名女性）RA患者和41名（23名男性，17名女性）健康受试者。该方法包括对QTc间期、晚电位、短期心率变异性（HRV）和非线性HRV（庞加莱图）进行综合心电图分析（使用席勒软件AT - 10）；进行24小时动态心电图监测并分析心电图QTc间期、HRV；进行24小时血压监测并分析收缩压和舒张压变异性；进行心血管自主神经反射测试（根据尤因法）。通过进行3项测试来确定迷走神经功能障碍：瓦尔萨尔瓦动作、深呼吸试验和站立试验时的心率反应。通过应用2项测试来检查交感神经系统功能障碍：站立时的血压反应和握力试验。
在所有心血管反射测试中，患者异常结果的发生率显著高于健康受试者。严重自主神经功能障碍在RA中更为常见。SLE患者的QTc间期延长更明显。与对照组相比，这两种疾病均与心率变异性降低有关，RA患者的降低幅度更大。在SLE患者中，自主神经功能障碍主要表现为交感神经活动增强，而在RA中迷走神经占优势明显。
SLE和RA与严重自主神经功能障碍以及与心脏性猝死发生相关的重要风险预测因素有关。
