Koszewicz M, Gosk-Bierska I, Jerzy G, Bilińska M, Podemski R, Budrewicz S, Adamiec R
Department of Neurology, Wrocław Medical University, Wrocław, Poland.
Int Angiol. 2011 Aug;30(4):375-9.
Different mechanisms (neural and intravascular) are thought to be important in the pathogenesis of Raynaud's phenomenon (RP). In a previous study we confirmed autonomic nervous system impairment in patients with primary RP, but the pathogenic role of peripheral nerves remained unclear. The aim of the current study was an electrophysiological analysis of peripheral nerves using both standard conduction velocity and the conduction velocity distribution (CVD) in patients with primary RP in order to investigate the causes of dysautonomia.
We examined 34 patients with primary RP and dysautonomia and 31 sex- and age-matched controls. Standard motor and sensory conduction tests in ulnar and peroneal (sural) nerves and a CVD test in the same nerves were performed.
Clinically, none of the patients had motor symptoms, while 35.3% of them presented sensory neuropathy. Standard neurographic tests were within the normal limits except for the significant prolongation of mean sensory latency in both examined nerves. CVD revealed significant slowing of motor conduction velocity in all the conduction values, e.g. in the 10th, 50th, and 90th percentiles of velocity. There were no differences in the width of the velocity distribution in the patient group and controls.
The results of CVD indicated the presence of generalized subclinical peripheral motor nerve impairment (subclinical polyneuropathy) in patients with primary RP and dysautonomia. Based on the present and previous studies, we conclude that the mechanism of autonomic dysfunction in primary RP is mixed, resulting from both central and peripheral neural abnormalities.
不同机制（神经和血管内）被认为在雷诺现象（RP）的发病机制中起重要作用。在先前的一项研究中，我们证实了原发性RP患者存在自主神经系统损害，但周围神经的致病作用仍不清楚。本研究的目的是对原发性RP患者的周围神经进行电生理分析，采用标准传导速度和传导速度分布（CVD），以研究自主神经功能障碍的原因。
我们检查了34例原发性RP和自主神经功能障碍患者以及31例性别和年龄匹配的对照。对尺神经和腓总（腓肠）神经进行标准运动和感觉传导测试，并对同一神经进行CVD测试。
临床上，所有患者均无运动症状，而35.3%的患者存在感觉神经病变。除了两条被检查神经的平均感觉潜伏期显著延长外，标准神经电图测试均在正常范围内。CVD显示所有传导值的运动传导速度均显著减慢，例如在速度的第10、50和90百分位数处。患者组和对照组的速度分布宽度没有差异。
CVD结果表明原发性RP和自主神经功能障碍患者存在全身性亚临床周围运动神经损害（亚临床多发性神经病）。基于目前和先前的研究，我们得出结论，原发性RP中自主神经功能障碍的机制是混合性的，由中枢和周围神经异常共同导致。
