Shindo Kazumasa, Fukao Toko, Kurita Naofumi, Satake Akane, Tsuchiya Mai, Ichinose Yuta, Hata Takanori, Koh Kishin, Nagasaka Takamura, Takiyama Yoshihisa
Department of Neurology, University of Yamanashi, 1110 Shimokatou, Chuo City, Yamanashi, 409-3898, Japan.
Neurol Sci. 2020 Aug;41(8):2241-2248. doi: 10.1007/s10072-020-04340-6. Epub 2020 Mar 21.
To find out the physiological method for evaluating the severity of central autonomic dysfunction, we performed detailed evaluation of cutaneous vasomotor neural function in a comparatively large sample of multiple system atrophy (MSA).
We evaluated cutaneous vasomotor neural function in 24 MSA patients. Skin sympathetic nerve activity (SSNA) and sympathetic skin response (SSR) and skin blood flow (skin vasomotor reflex [SVR]) were recorded at rest, as well as reflex changes after electrical stimulation. The parameters investigated were SSNA frequency at rest, reflex latency and amplitude of SSNA reflex bursts, absolute decrease and percent reduction of SVR, recovery time, and spontaneous SVR and SSR frequency.
There were negative correlations between resting SSNA and disease duration or the SCOPA-AUT score, but these were not significant. SSNA reflex latency displayed significant positive correlations with disease duration and SCOPA-AUT score (p < 0.001 and p < 0.01, respectively). In all five patients who underwent the same examination twice, SSNA reflex latency was significantly longer at the second examination than at the first examination (p < 0.005). A significant positive correlation was identified between recovery time of skin blood flow and SCOPA-AUT score or reflex latency (p < 0.05). Significant correlations were not observed between SCOPA-AUT score or disease duration and other parameters.
These results suggest that some MSA patients with a comparatively short duration of disease potentially have impaired thermoregulatory function. Measurement of sympathetic outflow to the skin is potentially a useful tool for predicting the severity of central autonomic dysfunction in MSA.
为了找出评估中枢自主神经功能障碍严重程度的生理学方法，我们在相对较大样本的多系统萎缩（MSA）患者中对皮肤血管运动神经功能进行了详细评估。
我们评估了24例MSA患者的皮肤血管运动神经功能。记录静息状态下的皮肤交感神经活动（SSNA）、交感皮肤反应（SSR）和皮肤血流量（皮肤血管运动反射[SVR]），以及电刺激后的反射变化。研究的参数包括静息时的SSNA频率、SSNA反射爆发的反射潜伏期和幅度、SVR的绝对降低值和降低百分比、恢复时间，以及自发SVR和SSR频率。
静息时的SSNA与病程或SCOPA-AUT评分之间存在负相关，但无统计学意义。SSNA反射潜伏期与病程和SCOPA-AUT评分呈显著正相关（分别为p < 0.001和p < 0.01）。在接受两次相同检查的所有5例患者中，第二次检查时的SSNA反射潜伏期明显长于第一次检查（p < 0.005）。皮肤血流量的恢复时间与SCOPA-AUT评分或反射潜伏期之间存在显著正相关（p < 0.05）。未观察到SCOPA-AUT评分或病程与其他参数之间存在显著相关性。
这些结果表明，一些病程相对较短的MSA患者可能存在体温调节功能受损。测量皮肤的交感神经输出可能是预测MSA中枢自主神经功能障碍严重程度的有用工具。
