Departments of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 804, Taiwan.
Int J Environ Res Public Health. 2020 Oct 23;17(21):7751. doi: 10.3390/ijerph17217751.
Autonomic disorders have been recognized as an important non-motor feature in Parkinson's disease (PD). However, there is a paucity of information on the presence and severity of cardiovascular autonomic neuropathy (CAN) among different motor phenotypes. The aims of this study were to examine the feasibility of electrochemical skin conductance (ESC) measured by Sudoscan as a screening service for CAN in patients with PD and investigate the severity of CAN among different motor phenotypes. Design: This was a cross-sectional observational study that enrolled 63 patients with PD. Patients were divided into three phenotypes, postural instability/gait difficulty (PIGD), tremor-dominant (TD), and akinetic-rigid (AR), according to their motor symptoms. Cardiovascular autonomic function was measured, and the presence and severity of CAN was determined according to the composite autonomic scoring scale (CASS). Functional scores were measured by the Hoehn and Yahr (HY) stage and the Unified Parkinson's Disease Rating Scale (UPDRS). The median HY stage was 2.0 [1.5, 3.0]. Median UPDRS total score was 23.0 (17.5, 30.5), 10.0 (6.0, 11.0) and 14.0 (6.3, 23.8) in groups of PIGD, TD and AR, respectively ( = 0.001). Mean CASS was 1.7 ± 1.3, 0.6 ± 0.4, and 1.8 ± 1.5 in groups of PIGD, TD and AR, respectively ( = 0.204). Although the ESC was not strongly associated with the cardiovascular autonomic parameters, the CAN risk score provided by Sudoscan significantly correlated with parameters of cardiovascular autonomic function, including heart rate response to deep breathing (HR_DB), Valsalva ratio (VR), and baroreflex sensitivity (BRS). By receiver-operating characteristic (ROC) analysis, if a patient's CAN risk score is higher than 33.5 (%), it is recommended to be aware of the presence of CAN even in PD patients who are asymptomatic. The area under ROC curve was 0.704. Based on our results, CAN risk score may be used for screening of CAN in patients with PD before resorting to the more sophisticated and specific, but ultimately more time-consuming, complete autonomic function testing.
自主神经障碍已被认为是帕金森病（PD）的一个重要非运动特征。然而，关于不同运动表型中心血管自主神经病变（CAN）的存在和严重程度的信息很少。本研究的目的是检查通过 Sudoscan 测量的电化学皮肤电导（ESC）作为 PD 患者 CAN 筛查服务的可行性，并研究不同运动表型中 CAN 的严重程度。设计：这是一项横断面观察性研究，共纳入 63 例 PD 患者。根据运动症状，患者分为姿势不稳/步态困难（PIGD）、震颤为主（TD）和无动性僵硬（AR）三种表型。心血管自主功能测量，根据综合自主评分量表（CASS）确定 CAN 的存在和严重程度。功能评分采用 Hoehn 和 Yahr（HY）分期和统一帕金森病评定量表（UPDRS）进行测量。中位 HY 分期为 2.0 [1.5，3.0]。PIGD、TD 和 AR 组的中位 UPDRS 总分分别为 23.0（17.5，30.5）、10.0（6.0，11.0）和 14.0（6.3，23.8）（= 0.001）。PIGD、TD 和 AR 组的平均 CASS 分别为 1.7±1.3、0.6±0.4 和 1.8±1.5（=0.204）。尽管 ESC 与心血管自主参数相关性不强，但 Sudoscan 提供的 CAN 风险评分与心血管自主功能参数显著相关，包括心率对深呼吸的反应（HR_DB）、瓦尔萨尔瓦比值（VR）和压力反射敏感性（BRS）。通过受试者工作特征（ROC）分析，如果患者的 CAN 风险评分高于 33.5（%），建议即使在无症状的 PD 患者中也要注意存在 CAN。ROC 曲线下面积为 0.704。根据我们的结果，CAN 风险评分可用于 PD 患者在进行更复杂、更具体但最终更耗时的全面自主功能测试之前进行 CAN 的筛查。
