Saraswathi P V, Neelambikai N, Mahesh Arjun, Govindarajan K
Department of Physiology, Coimbatore Medical College, Coimbatore--641 014, Tamil Nadu, India.
Indian J Physiol Pharmacol. 2013 Jan-Mar;57(1):23-30.
The autonomic dysfunction has been reported in patients with (rheumatoid arthritis) RA and systemic lupus erythematosus (SLE) like connective tissue disorders and it may be due to the vasculitis of vasa nervorum and secondary amyloidosis. The pathogenesis may also have an immune component that affects autonomic functions. In the present study, three standard cardiovascular parasympathetic function tests were performed in 207 RA patients and in 106 healthy controls. 14.45% patients were presented with symptoms related to cardiovascular autonomic dysfunction. Heart rate variation to deep breathing (DBD), standing (30:15 ratio), Valsalva ratio (VR) were found to be significantly reduced in RA patients and was weakly associated with female RA patients (r = 0.165, p = 0.018) and was not correlated to disease duration, RF positivity & severity of the disease. In conclusion, this study has confirmed the presence of significant subclinical cardiovascular parasympathetic nervous dysfunction in RA patients and its positive association with female gender. Hence, inclusion of cardiovascular autonomic function tests in the routine clinical examination may be helpful in the early detection of autonomic dysfunction in RA.
类风湿关节炎（RA）和系统性红斑狼疮（SLE）等结缔组织疾病患者中已报告存在自主神经功能障碍，这可能是由于营养神经血管炎和继发性淀粉样变所致。其发病机制也可能有影响自主神经功能的免疫成分。在本研究中，对207例RA患者和106例健康对照者进行了三项标准的心血管副交感神经功能测试。14.45%的患者出现与心血管自主神经功能障碍相关的症状。RA患者深呼吸时心率变异性（DBD）、站立时（30:15比值）、瓦尔萨尔瓦比值（VR）显著降低，且与女性RA患者呈弱相关（r = 0.165，p = 0.018），与疾病持续时间、类风湿因子阳性及疾病严重程度无关。总之，本研究证实RA患者存在明显的亚临床心血管副交感神经功能障碍，且与女性性别呈正相关。因此，在常规临床检查中纳入心血管自主神经功能测试可能有助于早期发现RA患者的自主神经功能障碍。
