Nishijima K, Ishiguro T
Seishin Shinkeigaku Zasshi. 1989;91(6):429-56.
In nine typical cases and five mild cases of neuroleptic malignant syndrome (NMS), homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and noradrenaline (NA) and 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) levels in the cerebrospinal fluid (CSF) were assayed both during the active phase of NMS and after recovery. Compared with levels in normal control subjects, the levels of HVA were significantly lower in the active phase of typical NMS. This finding supports the central dopamine blockade theory of NMS pathophysiology. In addition, the levels of HVA were significantly decreased after recovery from typical NMS. This suggests that there may be a decreased dopamine metabolism in patients susceptible to NMS. The levels of 5-HIAA in the active phase of typical NMS and after recovery were also significantly lower than those in normal control group, suggesting a relationship between the development of NMS and a disturbance of serotonin metabolism. In mild cases, the levels of HVA and 5-HIAA in the active phase of NMS and after recovery were not different from those in normal control subjects. This suggests that there may be a difference in dopamine and serotonin metabolism between typical cases and mild cases. In both cases, the levels of NA in patients with active NMS were significantly higher than in normal subjects, and were within a normal range after recovery. The levels of MHPG were significantly increased in the active phase of typical NMS and had a tendency to increase in the active phase of mild cases, compared with levels in normal control subjects. The levels of MHPG after recovery in both cases were not different from those in normal control subjects. These findings are a result of increased sympathetic activity in active NMS. However, these findings are also observed in other disorders and probably reflect the physical stress caused by NMS.
在9例典型病例和5例轻度抗精神病药恶性综合征（NMS）病例中，分别在NMS活动期及恢复后检测了脑脊液（CSF）中高香草酸（HVA）、5-羟吲哚乙酸（5-HIAA）、去甲肾上腺素（NA）和3-甲氧基-4-羟基苯乙二醇（MHPG）的水平。与正常对照受试者的水平相比，典型NMS活动期HVA水平显著降低。这一发现支持了NMS病理生理学的中枢多巴胺阻断理论。此外，典型NMS恢复后HVA水平也显著下降。这表明易患NMS的患者可能存在多巴胺代谢降低。典型NMS活动期及恢复后5-HIAA水平也显著低于正常对照组，提示NMS的发生与5-羟色胺代谢紊乱有关。在轻度病例中，NMS活动期及恢复后HVA和5-HIAA水平与正常对照受试者无异。这表明典型病例和轻度病例在多巴胺和5-羟色胺代谢方面可能存在差异。在这两种病例中，NMS活动期患者的NA水平均显著高于正常受试者，恢复后在正常范围内。与正常对照受试者相比，典型NMS活动期MHPG水平显著升高，轻度病例活动期有升高趋势。两种病例恢复后MHPG水平与正常对照受试者无异。这些发现是NMS活动期交感神经活动增强的结果。然而，在其他疾病中也观察到这些发现，可能反映了NMS引起的身体应激。
