Liu Bin-Bin, Zhao Bo-Wen, Wu Fei-Peng, Hu Tian, Zhao Yin, Zhang Hong
Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Curr Med Sci. 2023 Apr;43(2):376-383. doi: 10.1007/s11596-023-2701-1. Epub 2023 Mar 17.
This study aimed to examine the association of primary open-angle glaucoma (POAG) with autonomic dysfunction by assessing the differences in systemic and ocular responses to an autonomic provocation test, the Valsalva manoeuvre (VM), between POAG patients and normal subjects.
Forty POAG and forty control subjects were subjected to the VM. Systemic and ocular parameters were measured at baseline, phase 2, and phase 4 of the VM (VM2 and VM4), where VM2 and VM4 are sympathetic and parasympathetic nervous activation states, respectively. Heart rate variability was used to assess the autonomic nervous activity, among which the high-frequency component (HF) and the low-frequency (LF)/HF ratio were used as indices of parasympathetic and sympathetic activation, respectively.
POAG patients demonstrated higher sympathetic activation (LF/HF ratio median: 2.17 vs. 1.53, P=0.000) than controls at baseline and exhibited attenuated sympathetic and parasympathetic responses (a smaller change in LF/HF and HF values) during the VM than controls. During VM, the intraocular pressure (IOP), mean blood pressure (MAP), mean ocular perfusion pressure (MOPP), and the Schlemm's canal area (SCAR) increased from baseline to VM2 and then decreased from VM2 to VM4 in both the POAG and control groups (all P<0.05). However, when we compared the changes above, the fluctuations in IOP, MAP, and MOPP were more pronounced in POAG than in controls (all P<0.05), while the changes in amplitudes of SCAR were smaller in POAG (P<0.05). Furthermore, from VM2 to VM4, the choroid thickness (ChT) in the POAG group was significantly decreased, while it was unchanged in normal subjects (P=0.258). A regression analysis showed a significant correlation of the baseline LF/HF with IOP change values (ΔIOP) from baseline to VM2 in POAG (R=0.147, P=0.014).
Patients with POAG showed more pronounced fluctuations in IOP, MAP, MOPP and ChT during the VM than controls. These reactions could be associated with autonomic dysfunction in POAG.
本研究旨在通过评估原发性开角型青光眼（POAG）患者与正常受试者在自主神经激发试验——瓦尔萨尔瓦动作（VM）中全身和眼部反应的差异，来研究POAG与自主神经功能障碍之间的关联。
40例POAG患者和40例对照受试者接受了VM试验。在VM的基线、第2阶段和第4阶段（VM2和VM4）测量全身和眼部参数，其中VM2和VM4分别为交感神经和副交感神经激活状态。采用心率变异性评估自主神经活动，其中高频成分（HF）和低频（LF）/HF比值分别作为副交感神经和交感神经激活的指标。
POAG患者在基线时交感神经激活程度高于对照组（LF/HF比值中位数：2.17对1.53，P = 0.000），且在VM过程中交感神经和副交感神经反应减弱（LF/HF和HF值变化较小）。在VM过程中，POAG组和对照组的眼压（IOP）、平均血压（MAP）、平均眼灌注压（MOPP）和施莱姆管面积（SCAR）均从基线升高至VM2，然后从VM2降至VM4（所有P<0.05）。然而，当我们比较上述变化时，POAG患者的IOP、MAP和MOPP波动比对照组更明显（所有P<0.05），而POAG患者的SCAR振幅变化较小（P<0.05）。此外，从VM2到VM4，POAG组的脉络膜厚度（ChT）显著降低，而正常受试者则无变化（P = 0.258）。回归分析显示，POAG患者基线时的LF/HF与从基线到VM2的IOP变化值（ΔIOP）显著相关（R = 0.147，P = 0.014）。
与对照组相比，POAG患者在VM过程中IOP、MAP、MOPP和ChT的波动更明显。这些反应可能与POAG患者的自主神经功能障碍有关。
