Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan.
Department of Internal Medicine III, Shimane University Faculty of Medicine, Izumo, Japan.
J Neural Transm (Vienna). 2018 Feb;125(2):153-162. doi: 10.1007/s00702-017-1816-6. Epub 2017 Nov 28.
The aim of this study was to evaluate the autonomic neural function in Parkinson's disease (PD) and multiple system atrophy (MSA) with head-up tilt test and spectral analysis of cardiovascular parameters. This study included 15 patients with MSA, 15 patients with PD, and 29 healthy control (HC) subjects. High frequency power of the RR interval (RR-HF), the ratio of low frequency power of RR interval to RR-HF (RR-LF/HF) and LF power of systolic BP were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively. Both patients with PD and MSA showed orthostatic hypotension and lower parasympathetic function (RR-HF) at tilt position as compared to HC subjects. Cardiac sympathetic function (RR-LF/HF) was significantly high in patients with PD than MSA at supine position. RR-LF/HF tended to increase in MSA and HC, but decreased in PD by tilting. Consequently, the change of the ratio due to tilting (ΔRR-LF/HF) was significantly lower in patients with PD than in HC subjects. Further analysis showed that compared to mild stage of PD, RR-LF/HF at the supine position was significantly higher in advanced stage. By tilting, it was increased in mild stage and decreased in the advanced stage of PD, causing ΔRR-LF/HF to decrease significantly in the advanced stage. Thus, we demonstrated that spectral analysis of cardiovascular parameters is useful to identify sympathetic and parasympathetic disorders in MSA and PD. High cardiac sympathetic function at the supine position, and its reduction by tilting might be a characteristic feature of PD, especially in the advanced stage.
本研究旨在通过直立倾斜试验和心血管参数的频谱分析来评估帕金森病（PD）和多系统萎缩（MSA）患者的自主神经功能。该研究纳入了 15 例 MSA 患者、15 例 PD 患者和 29 名健康对照（HC）受试者。RR 间期高频功率（RR-HF）、RR 间期低频功率与 RR-HF 的比值（RR-LF/HF）和收缩压 LF 功率分别用于评估副交感神经、心脏交感神经和血管运动交感神经功能。与 HC 受试者相比，PD 和 MSA 患者在倾斜位时均表现为直立性低血压和较低的副交感神经功能（RR-HF）。与 MSA 相比，PD 患者在仰卧位时心脏交感神经功能（RR-LF/HF）更高。RR-LF/HF 在 MSA 和 HC 中倾向于增加，而在 PD 中则随倾斜而减少。因此，与 HC 相比，PD 患者的 RR-LF/HF 因倾斜而变化（ΔRR-LF/HF）显著降低。进一步分析表明，与 PD 的轻度阶段相比，仰卧位时的 RR-LF/HF 在晚期阶段显著升高。通过倾斜，PD 的轻度阶段增加，晚期阶段减少，导致晚期阶段的 ΔRR-LF/HF 显著降低。因此，我们表明心血管参数的频谱分析有助于识别 MSA 和 PD 中的交感和副交感神经紊乱。仰卧位时的高心脏交感神经功能及其随倾斜而减少可能是 PD 的特征，尤其是在晚期阶段。
