遗传性转甲状腺素淀粉样变性中的胃排空：自主神经病变的影响。
Gastric emptying in hereditary transthyretin amyloidosis: the impact of autonomic neuropathy.
机构信息
Departments of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
出版信息
Neurogastroenterol Motil. 2012 Dec;24(12):1111-e568. doi: 10.1111/j.1365-2982.2012.01991.x. Epub 2012 Aug 16.
BACKGROUND
Gastrointestinal (GI) complications are common in hereditary transthyretin amyloidosis and an autonomic dysfunction has been considered to explain these symptoms. The aim of this study was to investigate the impact of autonomic neuropathy on gastric emptying in hereditary transthyretin amyloidosis and to relate these findings to nutritional status, GI symptoms, gender, and age at disease onset.
METHODS
Gastric emptying was evaluated with gastric emptying scintigraphy. Spectral analysis of the heart rate variability and cardiovascular responses after tilt test were used to assess the autonomic function. The nutritional status was evaluated with the modified body mass index (s-albumine × BMI).
KEY RESULTS
Gastric retention was found in about one-third of the patients. A weak correlation was found between the scintigraphic gastric emptying rate and both the sympathetic (rs = -0.397, P < 0.001) and parasympathetic function (rs = -0.282, P = 0.002). The gastric emptying rate was slower in those with lower or both upper and lower GI symptoms compared with those without symptoms (median T(50) 123 vs 113 min, P = 0.042 and 192 vs 113 min, P = 0.003, respectively). Multiple logistic regression analysis showed that age of onset (OR 0.10, CI 0.02-0.52) and sympathetic dysfunction (OR 0.23, CI 0.10-0.51), but not gender (OR 0.76, CI 0.31-1.84) and parasympathetic dysfunction (OR 1.81, CI 0.72-4.56), contributed to gastric retention.
CONCLUSIONS AND INFERENCES
Gastric retention is common in hereditary transthyretin amyloidosis early after onset. Autonomic neuropathy only weakly correlates with gastric retention and therefore additional factors must be involved.
背景
胃肠道（GI）并发症在遗传性转甲状腺素淀粉样变性中很常见，并且已经认为自主神经功能障碍可以解释这些症状。本研究的目的是探讨自主神经病变对遗传性转甲状腺素淀粉样变性患者胃排空的影响，并将这些发现与营养状况、GI 症状、性别和疾病发病年龄相关联。
方法
使用胃排空闪烁显像术评估胃排空情况。心率变异性的频谱分析和倾斜试验后的心血管反应用于评估自主神经功能。使用改良的体重指数（s-白蛋白×BMI）评估营养状况。
主要结果
约三分之一的患者存在胃潴留。放射性核素胃排空率与交感神经（rs=-0.397，P<0.001）和副交感神经功能（rs=-0.282，P=0.002）之间存在弱相关性。与无症状患者相比，上、下胃肠道症状较低或同时存在上、下胃肠道症状的患者胃排空率较慢（中位 T（50）分别为 123 分钟和 192 分钟与 113 分钟，P=0.042 和 192 分钟与 113 分钟，P=0.003）。多因素逻辑回归分析显示，发病年龄（OR 0.10，95%CI 0.02-0.52）和交感神经功能障碍（OR 0.23，95%CI 0.10-0.51），但不是性别（OR 0.76，95%CI 0.31-1.84）和副交感神经功能障碍（OR 1.81，95%CI 0.72-4.56）与胃潴留有关。
结论
遗传性转甲状腺素淀粉样变性患者发病后早期胃潴留很常见。自主神经病变与胃潴留仅呈弱相关，因此还涉及其他因素。
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