Solla Paolo, Cadeddu Christian, Cannas Antonino, Deidda Martino, Mura Nicola, Mercuro Giuseppe, Marrosu Francesco
Department of Public Health, Clinical and Molecular Medicine, Movement Disorders Centre, University of Cagliari, Cagliari, Italy.
Department of Medical Sciences "Mario Aresu", University Hospital of Cagliari, University of Cagliari, Strada Statale 554, Km 4.500, Monserrato, 09042, Cagliari, Italy.
J Neural Transm (Vienna). 2015 Oct;122(10):1441-6. doi: 10.1007/s00702-015-1393-5. Epub 2015 Mar 24.
Parkinson's disease (PD) can present with different motor subtypes depending on the predominant symptoms (tremor or rigidity/bradykinesia). Slower disease progression and less cognitive decline are observed in tremor-dominant patients compared to those with akinetic-rigid subtype. Autonomic cardiovascular disorders have been described in parkinsonian patients, although the definite correlations with different subtypes of PD are not clear. In this context, heart rate variability (HRV) analysis represents a non-invasive and established tool in assessing cardiovascular autonomic modulation. We investigate cardiovascular autonomic modulation in PD patients with tremor dominant subtype in comparison to akinetic rigid dominant subtype subjects using HRV analysis. Twenty-eight PD patients (17 with tremor dominant subtype and 11 with akinetic rigid dominant subtype) were enrolled and compared to 17 age and sex-matched healthy controls. HRV was analyzed in time- and frequency-domains. Low-frequency (LF) values were significantly lower in the akinetic rigid dominant subtype than in the tremor dominant group [LF 41.4 ± 13.6 vs 55.5 ± 11.6 (p < 0.007)] indicating that the disease led to a more evident impairment of the baroreflex modulation of the autonomic outflow mediated by both sympathetic and parasympathetic systems in the first class of patients. These findings support the biological relevance of clinical subtypes supporting the idea of a different pathophysiological process between these subtypes. These differences also suggest that different subtypes may also result in different responses to therapy or in the possible development of cardiovascular side effects of dopaminergic drugs in these different populations.
帕金森病（PD）根据主要症状（震颤或强直/运动迟缓）可表现为不同的运动亚型。与运动不能-强直亚型患者相比，震颤为主型患者的疾病进展较慢，认知功能下降较少。帕金森病患者中已描述了自主心血管功能障碍，尽管与PD不同亚型的明确相关性尚不清楚。在这种情况下，心率变异性（HRV）分析是评估心血管自主神经调节的一种非侵入性且成熟的工具。我们使用HRV分析，比较震颤为主型PD患者与运动不能-强直为主型患者的心血管自主神经调节情况。纳入了28例PD患者（17例震颤为主型和11例运动不能-强直为主型），并与17例年龄和性别匹配的健康对照进行比较。对HRV进行时域和频域分析。运动不能-强直为主型的低频（LF）值显著低于震颤为主型组[LF 41.4±13.6 vs 55.5±11.6（p<0.007）]，表明在第一组患者中，该疾病导致交感和副交感神经系统介导的自主神经输出的压力反射调节受损更为明显。这些发现支持了临床亚型的生物学相关性，支持了这些亚型之间存在不同病理生理过程的观点。这些差异还表明，不同亚型可能也会导致对治疗的不同反应，或者在这些不同人群中多巴胺能药物可能产生的心血管副作用。
