Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, 66421 Homburg/Saar, Germany.
Clin Res Cardiol. 2010 Nov;99(11):701-6. doi: 10.1007/s00392-010-0170-6. Epub 2010 May 5.
Autonomic cardiovascular dysfunction is common in Parkinson's disease (PD). Imaging studies suggest loss of cardiac sympathetic nerves even in the absence of clinical signs of autonomic dysfunction. Aim of the study was to investigate the functional significance of autonomic cardiovascular denervation at early stages of PD.
Seven PD patients (Hoehn and Yahr class 1 or 1.5) without clinical signs of autonomic dysfunction and seven age-matched healthy control subjects were studied. To evaluate the pre- and post-synaptic components of sympathetic innervation, dose-response curves of isoproterenol (no neuronal uptake) and epinephrine (neuronal uptake) on heart rate, contractility, cardiac output and systemic vascular resistance were determined echocardiographically. Additionally, measurements of baroreflex sensitivity and 24-h heart rate variability were done.
The chronotropic and inotropic responses during stimulation with isoproterenol and epinephrine were similar in PD patients and control subjects. Assessment of baroreflex sensitivity yielded no difference. Of the parameters of 24-h heart rate variability, only measures of high-frequency heart rate variation that more purely reflect parasympathetic activity were significantly depressed in PD patients as compared with control subjects.
The results of our study using direct determination of catecholamine-mediated chronotropic and contractile responses provide evidence against a functionally relevant sympathetic dysfunction. Possibly, sympathetic denervation is incomplete and the remaining fibers are sufficient for the maintenance of autonomic control. In contrast, the depression of several parameters of heart rate variability supports a significant change of parasympathetic activity at an early stage of PD with subclinical autonomic failure.
自主心血管功能障碍在帕金森病（PD）中很常见。影像学研究表明，即使在没有自主功能障碍临床迹象的情况下，心脏交感神经也会丧失。本研究旨在探讨 PD 早期自主心血管去神经支配的功能意义。
研究纳入了 7 名无自主神经功能障碍临床迹象的 PD 患者（Hoehn 和 Yahr 分级 1 或 1.5 级）和 7 名年龄匹配的健康对照者。为了评估交感神经支配的前、后突触成分，通过超声心动图测定异丙肾上腺素（无神经元摄取）和肾上腺素（神经元摄取）对心率、收缩力、心输出量和全身血管阻力的剂量反应曲线。此外，还进行了血压反射敏感性和 24 小时心率变异性的测量。
PD 患者和对照组在异丙肾上腺素和肾上腺素刺激下的变时和变力反应相似。血压反射敏感性评估无差异。在 24 小时心率变异性的参数中，只有更纯粹反映副交感神经活动的高频心率变异性的测量值在 PD 患者中明显低于对照组。
我们使用直接测定儿茶酚胺介导的变时和收缩反应的研究结果提供了证据，表明自主神经功能障碍没有明显的功能相关性。可能是交感神经去神经支配不完全，剩余的纤维足以维持自主神经控制。相比之下，心率变异性的几个参数的降低支持 PD 早期存在自主神经衰竭的亚临床表现时副交感神经活动的显著变化。
