Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Department of Biomedical Data Science, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Eur J Neurol. 2024 Mar;31(3):e16158. doi: 10.1111/ene.16158. Epub 2023 Dec 12.
Multiple system atrophy (MSA) is a neurodegenerative disease with characteristic motor and autonomic symptoms. Impaired brain serotonergic innervation can be associated with various clinical indices of MSA; however, the relationship between clinical symptoms and cerebrospinal fluid (CSF) levels of 5-hydroxyindole acetic acid (5-HIAA), a main serotonin metabolite, has not been fully elucidated.
To compare CSF 5-HIAA levels between patients with MSA and healthy controls, we included 33 controls and 69 MSA patients with either predominant parkinsonian or cerebellar ataxia subtypes. CSF 5-HIAA levels were measured using high-performance liquid chromatography. Additionally, we investigated correlations between CSF 5-HIAA and various clinical indices in 34 MSA patients.
CSF 5-HIAA levels were significantly lower in MSA patients than in controls (p < 0.0001). Probable MSA patients had lower CSF 5-HIAA levels than possible MSA patients (p < 0.001). In MSA patients, CSF 5-HIAA levels were inversely correlated with scores in Parts 1, 2, and 4 of the Unified Multiple System Atrophy Rating Scale, and with systolic and diastolic blood pressure in Part 3. Structural equation modeling revealed significant paths between serotonin and clinical symptoms, and significance was highest for activities of daily living, walking, and body sway.
Serotonin dysfunction, as assessed by CSF 5-HIAA levels, may implicate greater MSA severity.
多系统萎缩（MSA）是一种具有特征性运动和自主神经症状的神经退行性疾病。受损的脑 5-羟色胺能神经支配可能与 MSA 的各种临床指标相关；然而，临床症状与脑脊液（CSF）5-羟吲哚乙酸（5-HIAA）水平之间的关系尚未完全阐明，5-HIAA 是 5-羟色胺的主要代谢产物。
为了比较 MSA 患者和健康对照组之间 CSF 5-HIAA 水平，我们纳入了 33 名对照组和 69 名 MSA 患者，包括以帕金森病或小脑共济失调为主的亚型。使用高效液相色谱法测量 CSF 5-HIAA 水平。此外，我们在 34 名 MSA 患者中调查了 CSF 5-HIAA 与各种临床指标之间的相关性。
MSA 患者的 CSF 5-HIAA 水平明显低于对照组（p<0.0001）。可能的 MSA 患者的 CSF 5-HIAA 水平低于可能的 MSA 患者（p<0.001）。在 MSA 患者中，CSF 5-HIAA 水平与统一多系统萎缩评定量表第 1、2 和 4 部分的评分以及第 3 部分的收缩压和舒张压呈负相关。结构方程模型显示，5-羟色胺与临床症状之间存在显著的路径，其中日常生活活动、行走和身体摇晃的相关性最高。
通过 CSF 5-HIAA 水平评估的 5-羟色胺功能障碍可能提示 MSA 严重程度更高。
