Wu C L, Denq J C, Harper C M, O'Brien P C, Low P A
Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Clin Auton Res. 1998 Dec;8(6):347-51. doi: 10.1007/BF02309626.
Autonomic dysfunction is a feature of some neuropathies and not others. It has been suggested that some clinical and electrophysiologic attributes are predictable of autonomic impairment detected using laboratory testing; however, dear guidelines are unavailable. We evaluated 138 relatively unselected patients with peripheral neuropathy who underwent neurologic evaluation, electromyography (EMG), nerve conduction studies, and autonomic function tests to determine which variables were predictive of laboratory findings of autonomic failure. The variables evaluated were 1) clinical somatic neuropathic findings, 2) clinical autonomic symptoms, and 3) electrophysiologic findings. Autonomic symptoms were strongly predictive (Rs = 0.40, p < 0.001) of autonomic failure. Among the non-autonomic indices, absent ankle reflexes were mildly predictive (Rs = 0.19, p = 0.022) of autonomic impairment, but all others were not (duration, clinical pattern, severity, weakness, sensory loss). Electrophysiologic changes of an axonal neuropathy predicted autonomic impairment while demyelinating neuropathy did not. We conclude that autonomic studies will most likely be abnormal in patients who have symptoms of autonomic involvement and those who have an axonal neuropathy.
自主神经功能障碍是某些神经病变的一个特征，而非其他神经病变的特征。有人提出，一些临床和电生理特征可预测通过实验室检测发现的自主神经损伤；然而，目前尚无明确的指导方针。我们评估了138例相对未经筛选的周围神经病变患者，这些患者接受了神经学评估、肌电图（EMG）、神经传导研究和自主神经功能测试，以确定哪些变量可预测自主神经功能衰竭的实验室检查结果。评估的变量包括：1）临床躯体神经病变表现；2）临床自主神经症状；3）电生理表现。自主神经症状对自主神经功能衰竭具有很强的预测性（Rs = 0.40，p < 0.001）。在非自主神经指标中，踝反射消失对自主神经损伤有轻度预测性（Rs = 0.19，p = 0.022），但其他指标（病程、临床类型、严重程度、无力、感觉丧失）则无此作用。轴索性神经病的电生理变化可预测自主神经损伤，而脱髓鞘性神经病则不能。我们得出结论，自主神经功能研究在有自主神经受累症状的患者以及患有轴索性神经病的患者中最有可能出现异常。
