纤维肌痛症的压力反射中心血管、血管运动和心肌分支:与疼痛、情感障碍、睡眠问题和疲劳的关联。

The cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia: Associations with pain, affective impairments, sleep problems, and fatigue.

机构信息

Department of Psychology, University of Jaén, Jaén, Spain.

Institute of Psychology, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.

出版信息

Psychophysiology. 2021 May;58(5):e13800. doi: 10.1111/psyp.13800. Epub 2021 Mar 1.

Abstract

This study investigated the cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia using the spontaneous sequence method. Systolic blood pressure (SBP), interbeat interval (IBI), stroke volume (SV), pre-ejection period (PEP), and total peripheral resistance (TPR) were continuously recorded in 40 fibromyalgia patients and 30 healthy individuals during a cold pressor test and a mental arithmetic task. Sequences of covariation between SBP and IBI (cardiac branch), SV and PEP (myocardial branch), and TPR (vasomotor branch) were identified. Baroreflex sensitivity (BRS) was represented by the slope of the regression line between values in the sequences; baroreflex effectiveness (BEI) was indexed by the proportion of progressive SBP changes that elicited reflex responses. Patients exhibited lower BRS in the three branches, lower BEI in the cardiac and vasomotor branches, and reduced reactivity in cardiac BRS and BEI, SBP, IBI, SV, and PEP. Moreover, BRS and BEI were inversely related to clinical pain, cold pressor pain, depression, trait anxiety, sleep problems, and fatigue. Reduced function of the three baroreflex branches implies diminished resources for autonomic inotropic, chronotropic, and vascular regulation in fibromyalgia. Blunted stress reactivity indicates a limited capacity for autonomic cardiovascular adjustment to situational requirements. The associations of BRS and BEI with pain perception may reflect the antinociceptive effects arising from baroreceptor afferents, where reduced baroreflex function may contribute to the hyperalgesia characterizing fibromyalgia. The associations with affective impairments, sleep problems, and fatigue suggest that baroreflex dysfunctions are also involved in the secondary symptoms of the disorder.

摘要

本研究采用自发性序列方法探讨了纤维肌痛症的心脏、血管运动和心肌反射分支。在冷加压试验和心算任务中,连续记录了 40 例纤维肌痛症患者和 30 例健康个体的收缩压(SBP)、心动间隔(IBI)、每搏量(SV)、射血前期(PEP)和总外周阻力(TPR)。确定了 SBP 和 IBI(心脏分支)、SV 和 PEP(心肌分支)和 TPR(血管运动分支)之间的协变序列。通过序列中值之间的回归线斜率表示反射敏感性(BRS);通过反射引起的 SBP 变化比例表示反射有效性(BEI)。患者在三个分支中的 BRS 较低,在心脏和血管运动分支中的 BEI 较低,以及在心脏 BRS 和 BEI、SBP、IBI、SV 和 PEP 方面的反应性降低。此外,BRS 和 BEI 与临床疼痛、冷加压疼痛、抑郁、特质焦虑、睡眠问题和疲劳呈负相关。三个反射分支的功能降低意味着纤维肌痛症自主神经变力、变时和血管调节资源减少。应激反应性降低表明自主心血管调节对情境要求的能力有限。BRS 和 BEI 与疼痛感知的关联可能反映了来自压力感受器传入的抗伤害感受效应,其中反射功能降低可能导致纤维肌痛症的痛觉过敏。与情感障碍、睡眠问题和疲劳的关联表明,反射功能障碍也涉及该疾病的次要症状。

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