周围神经病伴发心血管自主神经功能异常的临床研究  

Clinical study of cardiovascular autonomic nerve dysfunction in peripheral neuropathy

作　　者：丁岩[1,2] 崔博 杨西西 卫华[1] 李存江[1] Ding Yan;Cui Bo;Yang Xixi;Wei Hua;Li Cunjiang(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院河北医院神经内科,北京100053 [2]首都医科大学宣武医院神经内科

出　　处：《北京医学》2022年第7期577-580,共4页Beijing Medical Journal

摘　　要：目的 评估周围神经病患者心血管自主神经功能受累情况。方法 选取2021年7月至2022年3月首都医科大学宣武医院神经内科收治的周围神经病患者23例,男16例,女7例,平均年龄(45±16)岁。其中吉兰-巴雷综合征5例,慢性炎性脱髓鞘性多发性神经病、糖尿病性周围神经病、免疫介导性周围神经病、血管炎性周围神经病各3例,其他类型周围神经病6例。通过节律性深呼吸的心率反应评估心脏迷走神经(副交感)功能,并通过心率和血压对直立倾斜的反应来评估交感肾上腺素能功能。结果 23例患者全部完成自主神经功能检查,其中迷走神经功能和心血管交感神经功能均异常的患者有11例,占47.8%。迷走神经功能评估显示,心率对深呼吸反应正常的患者4例,异常19例,异常占82.6%。直立倾斜试验显示,直立性低血压(orthostatic hypotension, OH)患者14例(60.9%),其中11例在直立后出现轻微的症状,3例无不适症状。结论 周围神经病患者的心脏迷走神经功能和交感神经功能均出现不同程度的损害。由于心血管自主神经功能异常会造成患者猝死或突发循环衰竭,因此应引起患者和医师的关注。Objective To evaluate the cardiovascular autonomic nerve function involvement in patients with peripheral neuropathy. Methods A total of 23 patients with peripheral neuropathy, including 16 males and seven females, with an average age of(45 ± 16) years, were selected from the Department of Neurology, Xuanwu Hospital, Capital Medical University from July 2021 to March 2022. There were Guillain-Barre syndrome in five cases, chronic inflammatory demyelinating polyneuropathy, diabetic peripheral neuropathy, immune-mediated peripheral neuropathy and vasculitic peripheral neuropathy in three cases, respectively, and other peripheral neuropathy in six cases. Cardiovagal(parasympathetic) function was assessed by rhythmic deep breath heart rate and sympathetic adrenergic function was assessed by head-up tilt heart rate and blood pressure. Results All of the 23 patients completed the examination of autonomic nerve function, among which 11 patients(47.8%) had both abnormal vagal nerve function and cardiovascular sympathetic nerve function. The evaluation of vagus nerve function showed that the heart rate was normal in four patients,and abnormal in 19 patients which accounted for 82.6%.The head-up tilt results showed that there were 14 patients(60.9%) with orthostatic hypotension(OH), among which 11patients showed slight symptoms and three patients had no uncomfortable symptoms. Conclusions Cardiac vagus and sympathetic nerve functions are impaired in different extent in patients with peripheral neuropathy. Patients and physicians should pay more attention to the abnormal cardiovascular autonomic nerve function which can cause sudden death or circulatory failure.

关 键 词：周围神经病 自主神经 迷走神经 交感神经功能 副交感神经功能 直立性低血压 

分 类 号：R745[医药卫生—神经病学与精神病学] R54[医药卫生—临床医学]