Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, 466-8550, Japan.
Department of Clinical Laboratory, Nagoya University Hospital, Nagoya, Japan.
Clin Auton Res. 2020 Jun;30(3):231-238. doi: 10.1007/s10286-020-00675-4. Epub 2020 Mar 7.
Neurodegeneration of the nucleus ambiguus and the dorsal vagal motor nucleus has been implicated in cardiac parasympathetic dysfunction in multiple system atrophy (MSA). The nucleus ambiguus and the dorsal vagal motor nucleus, which are located in the medulla oblongata (MO), control the autonomic-specifically, the parasympathetic-functions of the body. The aim of our study was to investigate the relationship between cardiac parasympathetic dysfunction and the anteroposterior diameter of the MO in MSA by quantitatively analyzing magnetic resonance imaging (MRI) outcome measures.
We retrospectively assessed 40 consecutive patients with probable MSA and 25 age- and sex-matched controls. The anteroposterior diameter of the MO at two locations (MO diameter-A and -B) and the diameters of the midbrain and pons were measured by conventional MRI. A cardiac parasympathetic function score (CP-score) and cardiac sympathetic function score (CS-score) were generated by calculating the z-scores of multiple autonomic function tests. The relationship between the scores and the measured diameters of the brainstem was also investigated.
The CP-score and CS-score were significantly lower in the patients with MSA than in the controls (CP-score: 0.61 ± 0.75 vs. - 0.38 ± 0.52, p < 0.001; CS-score: 0.91 ± 1.06 vs. - 0.57 ± 1.07, p < 0.001). Also, in the patients with MSA, the CP-score was significantly correlated with MO diameter-A (r = 0.40, p = 0.010), and the CS-score was significantly correlated with the diameter of the midbrain (r = 0.33, p = 0.038).
The anteroposterior diameter of the MO is a potential imaging marker of parasympathetic dysfunction in MSA.
在多系统萎缩（MSA）中，疑核和背侧迷走运动核的神经退行性变与心脏副交感神经功能障碍有关。疑核和背侧迷走运动核位于延髓（MO），控制自主神经，特别是副交感神经的功能。我们的研究目的是通过定量分析磁共振成像（MRI）结果来探讨 MSA 中心脏副交感神经功能障碍与 MO 前后径之间的关系。
我们回顾性评估了 40 例连续的 MSA 患者和 25 名年龄和性别匹配的对照组。通过常规 MRI 测量 MO 的两个位置（MO 直径-A 和 -B）和中脑及桥脑的直径。通过计算多项自主神经功能测试的 z 分数，生成心脏副交感功能评分（CP-score）和心脏交感功能评分（CS-score）。还研究了这些评分与脑干测量直径之间的关系。
MSA 患者的 CP-score 和 CS-score 明显低于对照组（CP-score：0.61±0.75 对 -0.38±0.52，p<0.001；CS-score：0.91±1.06 对 -0.57±1.07，p<0.001）。此外，在 MSA 患者中，CP-score 与 MO 直径-A 显著相关（r=0.40，p=0.010），CS-score 与中脑直径显著相关（r=0.33，p=0.038）。
MO 的前后径是 MSA 中副交感神经功能障碍的潜在影像学标志物。
