Ankara Training and Research Hospital, Clinic of Physical Medicine and Rehabilitation, Cebeci, Ulucanlar, Ankara, Turkey.
Clin Rheumatol. 2012 Jan;31(1):41-7. doi: 10.1007/s10067-011-1763-9. Epub 2011 May 20.
Studies that have evaluated autonomic nervous system (ANS) function in Behçet disease (BD) are rare and have indicated conflicting results with different degrees of involvement. The aim of this study was to investigate ANS function by using electrophysiological tests in patients with BD and to determine the relationship between the disease activity parameters and the indicators of autonomic activity. We included 70 BD patients and 50 healthy controls. Demographic characteristics including age, sex, and disease duration were recorded. A detailed neurological examination was performed, and clinical autonomic symptoms were recorded. The Behçet Disease Current Activity Form (BDCAF) was used to determine the disease activity. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were determined for laboratory activity. The electrophysiological assessments of ANS function were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) tests. The mean values of sympathetic (SSR latency and amplitude) and parasympathetic (RRIV at rest [R%] and deep breathing [D%], D% - R%, and D%/R%) parameters were compared, and any correlations between ANS parameters and clinical disease characteristics were determined. Seventy BD patients (23 males, 47 females) with a mean age of 41.2 ± 10.01 years and 50 control subjects (18 males, 32 females) with a mean age of 39.5 ± 8.94 years were included in the study. All the subjects were totally symptom free with respect to ANS involvement, and the subjects in both groups had normal neurological examination findings. The demographic characteristics were similar between the groups. The mean latency of SSR was increased (1.4 ± 0.4 vs 0.7 ± 0.8), and R% (0.3 ± 0.3 vs 0.5 ± 0.4) and D% (0.3 ± 0.3 vs 0.6 ± 0.5) values were decreased in BD patients compared to control subjects. No correlation was found between BDCAF scores and ANS variables. However, there was a significant correlation between SSR latency and ESR and CRP values (p < 0.01, r = -0.25, r = -0.31, respectively) in the patient group, indicating a more sympathetic dysautonomia in patients with active laboratory parameters. In conclusion, our study indicates a subclinical sympathetic and parasympathetic autonomic dysfunction in patients with BD, which may be related with disease activity. As the early recognition of abnormalities in ANS may be very important in order to prevent excessive morbidity, simple electrophysiological methods are suggested to identify Behçet patients at high risk for symptomatic dysautonomia.
本研究旨在通过电生理学测试评估 BD 患者的自主神经功能，并确定疾病活动参数与自主活动指标之间的关系。我们纳入了 70 名 BD 患者和 50 名健康对照者。记录了人口统计学特征，包括年龄、性别和疾病持续时间。进行了详细的神经系统检查，并记录了临床自主神经症状。使用 Behçet 疾病活动表（BDCAF）来确定疾病活动度。测定红细胞沉降率（ESR）和 C 反应蛋白（CRP）水平以评估实验室活动度。通过交感皮肤反应（SSR）和 R-R 间期变化（RRIV）测试评估自主神经功能的电生理学评估。比较了自主神经（SSR 潜伏期和振幅）和副交感神经（RRIV 在休息时的 R%和深呼吸时的 D%、D% - R%、D%/R%）参数的平均值，并确定了自主神经参数与临床疾病特征之间的任何相关性。70 名 BD 患者（23 名男性，47 名女性）的平均年龄为 41.2±10.01 岁，50 名对照者（18 名男性，32 名女性）的平均年龄为 39.5±8.94 岁。所有患者均无自主神经受累的症状，两组患者的神经系统检查均正常。组间的人口统计学特征相似。BD 患者的 SSR 潜伏期延长（1.4±0.4 比 0.7±0.8），R%（0.3±0.3 比 0.5±0.4）和 D%（0.3±0.3 比 0.6±0.5）值降低。BDCAF 评分与自主神经变量之间无相关性。然而，在患者组中，SSR 潜伏期与 ESR 和 CRP 值呈显著相关（p<0.01，r=-0.25，r=-0.31），表明具有活跃实验室参数的患者存在更明显的交感神经自主神经功能障碍。总之，本研究表明 BD 患者存在亚临床的交感和副交感自主神经功能障碍，这可能与疾病活动有关。由于早期识别自主神经异常对于预防过高的发病率非常重要，因此建议使用简单的电生理方法来识别存在症状性自主神经功能障碍高风险的 Behçet 患者。
