Medizinische Klinik IV, Rheumaeinheit, Klinikum der Universität München, Munich, Germany.
Abteilung für Nephrologie, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Clin Auton Res. 2017 Dec;27(6):385-392. doi: 10.1007/s10286-017-0463-1. Epub 2017 Sep 1.
To assess autonomic function by infrared dynamic pupillometry in patients with ANCA-vasculitis (AAV) in correlation to autonomic symptoms, disease specific clinical parameters and cardiovascular reflex tests.
Patients with AAV and healthy controls underwent pupillometry at rest and after sympathetic stimulation (cold pressor test). Three parasympathetic parameters (amplitude, relative amplitude, maximum constriction velocity) and one sympathetic parameter (late dilatation velocity) were assessed. Results were correlated with clinical parameters, symptoms of autonomic dysfunction (COMPASS31 questionnaire), heart rate variability during deep breathing test and blood pressure response to pain.
23 patients and 18 age-matched controls were enrolled. Patients had a smaller amplitude (1.44 vs. 1.70 mm; p = 0.009) and a slower constriction velocity (4.15 vs. 4.71 mm/s; p = 0.028) at baseline and after sympathetic stimulation (1.47 vs. 1.81 mm, p = 0.001; 4.38 vs. 5.19 mm/s, p = 0.006, respectively). Relative amplitude was significantly smaller in patients after sympathetic stimulation (28.6 vs. 32.5%; p = 0.043), but not at baseline. There was no difference in sympathetic pupillary response between the groups. In patients, parasympathetic pupil response was correlated negatively with age and positively with parasympathetic cardiac response. After adjusting for age, no significant correlation was observed with clinical parameters. However, there was a trend towards a negative correlation with disease duration, vasculitis damage index and CRP.
Patients with AAV exhibit parasympathetic pupillary autonomic dysfunction. Although correlations were weak and not significant, pupillary autonomic dysfunction is rather linked to chronic damage than to active inflammation or symptoms of autonomic dysfunction.
通过红外动态瞳孔测量评估抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者的自主神经功能，并将其与自主神经症状、疾病特异性临床参数和心血管反射测试相关联。
AAV 患者和健康对照者接受瞳孔测量，分别在静息状态和交感神经刺激（冷加压试验）后进行。评估了三个副交感神经参数（振幅、相对振幅、最大收缩速度）和一个交感神经参数（后期扩张速度）。结果与临床参数、自主神经功能障碍症状（COMPASS31 问卷）、深呼吸试验期间的心率变异性和疼痛引起的血压反应相关联。
共纳入 23 例患者和 18 名年龄匹配的对照者。患者在基线和交感神经刺激后，振幅较小（1.44 比 1.70mm；p=0.009）和收缩速度较慢（4.15 比 4.71mm/s；p=0.028）。在交感神经刺激后，相对振幅也显著较小（28.6 比 32.5%；p=0.043），但在基线时无差异。两组间的交感神经瞳孔反应无差异。在患者中，副交感神经瞳孔反应与年龄呈负相关，与副交感神经心脏反应呈正相关。在调整年龄后，与临床参数无显著相关性。然而，与疾病持续时间、血管炎损伤指数和 CRP 呈负相关趋势。
AAV 患者存在副交感神经瞳孔自主神经功能障碍。尽管相关性较弱且不显著，但瞳孔自主神经功能障碍与慢性损伤而不是与活动炎症或自主神经功能障碍症状相关。
