Studer Valeria, Rocchi Camilla, Motta Caterina, Lauretti Benedetta, Perugini Jacopo, Brambilla Laura, Pareja-Gutierrez Lorena, Camera Giorgia, Barbieri Francesca Romana, Marfia Girolama A, Centonze Diego, Rossi Silvia
Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy.
Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Isitituto Neurologico Carlo Besta, Italy.
Mult Scler J Exp Transl Clin. 2017 Apr 5;3(2):2055217317701317. doi: 10.1177/2055217317701317. eCollection 2017 Apr-Jun.
Sympathovagal imbalance has been associated with poor prognosis in chronic diseases, but there is conflicting evidence in multiple sclerosis.
The objective of this study was to investigate the autonomic nervous system dysfunction correlation with inflammation and progression in multiple sclerosis.
Heart rate variability was analysed in 120 multiple sclerosis patients and 60 healthy controls during supine rest and head-up tilt test; the normalised units of low frequency and high frequency power were considered to assess sympathetic and vagal components, respectively. Correlation analyses with clinical and radiological markers of disease activity and progression were performed.
Sympathetic dysfunction was closely related to the progression of disability in multiple sclerosis: progressive patients showed altered heart rate variability with respect to healthy controls and relapsing-remitting patients, with higher rest low frequency power and lacking the expected low frequency power increase during the head-up tilt test. In relapsing-remitting patients, disease activity, even subclinical, was associated with lower rest low frequency power, whereas stable relapsing-remitting patients did not differ from healthy controls. Less sympathetic reactivity and higher low frequency power at rest were associated with incomplete recovery from relapse.
Autonomic balance appears to be intimately linked with both the inflammatory activity of multiple sclerosis, which is featured by an overall hypoactivity of the sympathetic nervous system, and its compensatory plastic processes, which appear inefficient in case of worsening and progressive multiple sclerosis.
交感迷走神经失衡与慢性疾病的不良预后相关，但在多发性硬化症中存在相互矛盾的证据。
本研究的目的是调查自主神经系统功能障碍与多发性硬化症炎症和进展的相关性。
对120例多发性硬化症患者和60例健康对照者在仰卧休息和头高位倾斜试验期间进行心率变异性分析；分别考虑低频和高频功率的标准化单位来评估交感和迷走神经成分。对疾病活动和进展的临床及影像学标志物进行相关性分析。
交感神经功能障碍与多发性硬化症的残疾进展密切相关：进展型患者与健康对照者及复发缓解型患者相比，心率变异性发生改变，静息时低频功率更高，且在头高位倾斜试验期间缺乏预期的低频功率增加。在复发缓解型患者中，疾病活动（即使是亚临床的）与静息时较低的低频功率相关，而病情稳定的复发缓解型患者与健康对照者无差异。交感反应性较低和静息时低频功率较高与复发后不完全恢复相关。
自主神经平衡似乎与多发性硬化症的炎症活动密切相关，其特征是交感神经系统整体活动减退，也与代偿性可塑性过程密切相关，在病情恶化和进展型多发性硬化症中，这些过程似乎效率低下。
