Chida K, Takasu T, Kawamura H
Department of Neurology, Nihon University School of Medicine, Tokyo, Japan.
Nihon Arukoru Yakubutsu Igakkai Zasshi. 1998 Feb;33(1):45-55.
We examined sympathetic and parasympathetic function in 17 chronic alcoholics. The subjects were divided into 4 groups; (1) alcoholics without neurologic deficits, (2) alcoholics with mild neuropathy, (3) alcoholics with prominent neuropathy, (4) patients with alcoholic neuropathy but long abstinence. We measured pulsatile arterial pressure (AP) noninvasively and heart rate (HR) was calculated from the AP signals. The sweat response on the palm and sole were measured by ventilated capsular method, while the cutaneous blood flow response by laser Doppler flowmetry. The AP, HR, sweating and cutaneous blood flow response to the Valsalva maneuver were evaluated. In alcoholics with minimal and prominent neuropathy, a pressor (overshooting) in phase IV of the Valsalva maneuver were decreased significantly. The HR response (reflex bradycardia) in phase IV of the Valsalva maneuver was significantly decreased only in alcoholics with prominent neuropathy. The alcoholics with no or minimal neuropathy showed exaggerated sweat responses on the palm and sole. In prominent alcoholic neuropathy, the sweat response was greater on the palm, but diminished on the sole. In no or minimal neuropathy, magnitude of the blood flow response was markedly reduced on both sites. The low resting blood flow levels may contribute to the diminished response. We also evaluated pupillary light reflex and response to methacholine in 7 alcoholics with neuropathy by a portable infrared pupillometer system that can be used with personal computers. Maximum constriction velocity of the pupillary light reflex in patients with alcoholic neuropathy was slower than that in the controls. Reflex amplitude was smaller in the alcoholics than that in the control. However, local administration of methacholine did not change pupillary size and light reflex in the alcoholics same as the controls. The data suggest that preceding sympathetic hyperfunction related with distressed autonomic center is existing with sympathetic hypofunction involved from the sympathetic fibers, target organs and higher center.
我们研究了17名慢性酒精中毒患者的交感神经和副交感神经功能。受试者被分为4组：（1）无神经功能缺损的酒精中毒患者；（2）轻度神经病变的酒精中毒患者；（3）显著神经病变的酒精中毒患者；（4）患有酒精性神经病变但已长期戒酒的患者。我们采用无创方法测量搏动性动脉压（AP），并根据AP信号计算心率（HR）。通过通气囊法测量手掌和脚底的出汗反应，同时用激光多普勒血流仪测量皮肤血流反应。评估了Valsalva动作时的AP、HR、出汗和皮肤血流反应。在神经病变轻微和显著的酒精中毒患者中，Valsalva动作第四阶段的升压（过冲）明显降低。仅在神经病变显著的酒精中毒患者中，Valsalva动作第四阶段的HR反应（反射性心动过缓）明显降低。无或轻度神经病变的酒精中毒患者手掌和脚底出汗反应过度。在显著的酒精性神经病变中，手掌出汗反应增强，但脚底出汗反应减弱。在无或轻度神经病变时，两个部位的血流反应幅度均明显降低。静息血流水平较低可能导致反应减弱。我们还通过可与个人计算机一起使用的便携式红外瞳孔计系统，评估了7名患有神经病变的酒精中毒患者的瞳孔对光反射和对乙酰甲胆碱的反应。酒精性神经病变患者的瞳孔对光反射最大收缩速度比对照组慢。酒精中毒患者的反射幅度比对照组小。然而，与对照组一样，局部给予乙酰甲胆碱并未改变酒精中毒患者的瞳孔大小和对光反射。数据表明，之前与自主神经中枢功能紊乱相关的交感神经功能亢进与交感神经纤维、靶器官和高级中枢受累导致的交感神经功能减退同时存在。
