1 International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia , Vancouver, British Columbia, Canada .
J Neurotrauma. 2014 May 1;31(9):789-97. doi: 10.1089/neu.2013.3148. Epub 2014 Jan 30.
Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population.
脊髓损伤不仅会导致感觉运动障碍，还会导致自主神经损伤。心血管系统自主控制的丧失会导致脊髓损伤（SCI）患者的血压（BP）严重失调，因此可能会增加该人群患心血管疾病（CVD）的风险。使用动态血压监测（ABPM）可以深入了解昼夜血压谱，昼夜血压谱在健全受试者的心血管发病率和死亡率方面具有良好的预后价值。过去在 SCI 患者中使用 ABPM 的研究表明，昼夜血压模式的改变取决于脊髓损伤水平。与截瘫和健全受试者相比，四肢完全感觉运动损伤的四肢瘫痪患者白天动脉血压降低，失去生理性夜间血压下降，昼夜血压变异性增加，包括可能危及生命的高血压发作，称为自主反射异常（AD）。这些不良血压变化的潜在机制主要归因于控制心脏和血管的交感脊髓节前神经元的中枢驱动丧失或减少。此外，脊髓和外周的一些适应性解剖变化，以及 SCI 患者日常体力活动的普遍减少，也是导致不良血压变化的原因。ABPM 可以识别 SCI 患者的不良血压谱和相关 CVD 风险增加。同时，它也可能为监测 SCI 人群中 AD 的改善和夜间下降的丧失提供有用的临床工具。
