Autonomic Nerve Dysfunction is Closely Associated with the Abnormalities of Esophageal Motility in Reflux Esophagitis

Background: While reflux esophagitis (RE) is often associated with esophageal motility dysfunction, the causes of this abnormal motility are not well understood. The aim of our study was to assess the relationship between esophageal motility and autonomic nerve dysfunction by comparing 14 healthy control subjects (11 M, 3 F; mean age, 56.4 years) with 26 patients with RE (19 M, 7 F; mean age, 60.4 years). Methods: According to results of esophageal manometry, subjects with RE were assigned to group I (RE with esophageal motility dysfunction, n?=?12) or group N (RE without motility dysfunction, n?=?14). Autonomic neuropathy was assessed by measuring the heart rate coefficient of variation at rest (CVR-R), the Valsalva ratio for the R-R interval, the systolic blood pressure response to mental calculation, and the antral contractile response to modified sham feeding (MSF). Results: CVR-R at rest was lower in group I (2.08?±?0.18) than in group N (3.80?±?0.44; P?P?Conclusions: We conclude that esophageal motor dysfunction in some patients with RE may result from autonomic dysfunction.     

自主神经干预对心房恢复性质的影响

Objective This study aimed to investigate the effects of autonomic interventions on the restitution properties on the atria. Methods In 10 open-chest dogs,multiple electrode catheters were sutured at multiple pulmonary vein(PV) and atrial sites. The monophasic action potential was recorded by an AgAgCl catheter. The restitution curve at each site was constructed before and after vagal stimulation or ganglionated plexi(GP) ablation. The atrial fibrillation(AF) inducibility and duration induced by burst pacing were measured at each site before and after ipsolateral vagal stimulation or GP ablation. Results Before GP ablation, vagal stimulation markedly shortened the action potential duration (APD), decreased the slope of the restitution curves and the APD alternans cycle length, while increased the AF inducibility and duration once induced at each site( P ＜ 0. 05 ). These effects were eliminated by GP ablation. Compared to baseline,GP ablation significantly increased the APD, steepened the restitution curves and facilitated the APD alternans while decreased the AF inducibility and duration ( P ＜ 0. 05 ). VNS significantly increased ( 0. 5 ± 0. 2 vs. 0. 3 ±0. 1 ,P ＜ 0. 05 ) and GP ablation decreased (0. 2 ± 0. 1 vs. 0. 3 ± 0. 1, P ＜ 0. 05 ) the spatial dispersion of the slopes of APD restitution curves, respectively. Conclusions The maximal slope of APD restitution curve alone does not fully account for the changes of AF inducibility and duration induced by autonomic interventions; instead, the spatial dispersion of the APD restitution curves of Smax may be an important determinant for susceptibility of AF.     

自主神经干预对心房恢复性质的影响

目的 研究心脏自主神经干预对心房恢复性质的影响.方法 正常成年杂种犬10只,开胸后将多极电生理导管缝置于肺静脉、左右心耳和左右心房处,应用Ag-AgCl电极记录标测部位单相动作电位,在基础状态和颈部迷走神经刺激条件下构建标测部位恢复曲线,分别对标测部位进行快速电刺激,记录心房颤动（房颤）诱发时的起搏周长和持续时间.心脏自主神经节（GP）消融后重复上述步骤.结果 GP消融前迷走神经刺激同基础状态相比显著缩短动作电位时限（APD）,降低恢复曲线最大斜率（Smax）,抑制APD电交替,但房颤容易发生（P＜0.05）.GP消融后,APD较消融前显著延长,恢复曲线Smax增大,APD电交替提前,但房颤不易诱发（P＜0.05）;GP消融后迷走神经刺激效应明显减弱.GP消融前迷走神经刺激能显著增加APD恢复曲线Smax离散度（0.5±0.2对0.3±0.1,P＜0.05）,而GP消融能显著降低APD恢复曲线Smax离散度（0.2±0.1对0.3±0.1,P＜0.05）.结论 恢复曲线的斜率并不能完全解释房颤的诱发和维持,心房APD电交替可能对房颤的诱发并无预测作用,恢复性质的离散可能是诱发房颤的重要因素.     

Prospective Study of Autonomic Nerve Function in Type 1 and Type 2 Diabetic Patients: 24 Hour Heart Rate Variation and Plasma Motilin Levels Disturbed in Parasympathetic Neuropathy

To clarify the impact of autonomic neuropathy in diabetic patients, we have conducted a prospective study of 58 Type 1 and 51 Type 2 diabetic patients (investigated at baseline, after 4, and after 7 years). In Type 1 diabetic patients, the sympathetic nerve function (orthostatic acceleration and brake indices) and in Type 2 patients, parasympathetic nerve function (R-R interval variation; E/I ratio) deteriorated during 7 years of prospective observation. Symptoms of autonomic neuropathy were associated with signs of autonomic neuropathy (low brake indices) in Type 1 but not in Type 2 diabetic patients. In the latest assessment 24 h ECG recording was performed and blood samples assayed for neuropeptide Y (NPY) and motilin were obtained. Type 1 diabetic patients with parasympathetic neuropathy (abnormal E/I ratio) showed significantly lower SD value (less variation in the R-R intervals; 29 [17] vs 50 [16], [mean {interquartile range}]; p = 0.001) and higher postprandial plasma motilin values (70 [20] pmol I^?1 vs 50 [15] pmol I^?1; p< 0.01) than patients with normal parasympathetic nerve function. In Type 2 diabetic patients, sympathetic neuropathy (low brake indices) was associated with an increased frequency of ventricular extra systolic beats during 24 h ECG recording (r_s = 0.65; p<0.01). Postprandial plasma NPY levels were not associated with disturbed autonomic nerve function.     

Autonomic Modulation by Electrical Stimulation of the Parasympathetic Nervous System: An Emerging Intervention for Cardiovascular Diseases

The cardiac autonomic nervous system has been known to play an important role in the development and progression of cardiovascular diseases. Autonomic modulation by electrical stimulation of the parasympathetic nervous system, which increases the parasympathetic activity and suppresses the sympathetic activity, is emerging as a therapeutic strategy for the treatment of cardiovascular diseases. Here, we review the recent literature on autonomic modulation by electrical stimulation of the parasympathetic nervous system, including vagus nerve stimulation, transcutaneous auricular vagal stimulation, spinal cord stimulation, and ganglionated plexi stimulation, in the treatment of heart failure, atrial fibrillation, and ventricular arrhythmias.     

The problem of autonomic neuropathy in diabetic pregnancy

The hazards of pregnancy for both the mother and the fetus in diabetic women with severe retinopathy and nephropathy are well reported. We wish to highlight a poorly recognized problem in the obstetric management of the diabetic mother, that of pregnancy in a patient with autonomic neuropathy. Two such cases are reported where the presence of autonomic neuropathy severely jeopardized the health of the mother, with the loss of the fetus in one, due to occurrence of severe and intractable vomiting. The presence of moderate to severe symptomatic diabetic autonomic neuropathy, particularly with evidence of gastroparesis, may be a relative contraindication to pregnancy.     

心率变异性分析对糖尿病合并自主神经病变的诊断价值

采用24小时标准差法（SDNN）和心率变异指数法（HRVI），分析34例Ⅱ型糖尿病患者和42例正常人的心率变异（HRV），结果发现Ⅱ型糖尿病患者的HRV显著低于正常人（P＜0．05）。糖尿病合并自主神经病变（AN）者HRV显著低于不合并AN者。HRV与呼吸差、立卧差、30／15比值和乏氏指数呈正相关（γ分别为：0．86，0．90，0．78，0．81，P＜0．05）。如将SDNN＜30ms作为判定糖尿病合并AN的指标，敏感性是80．0％，特异性是84．2％。提示HRV可作为评价糖尿病合并AN的指标。     

肝硬化患者植物神经功能变化

目的　探讨肝硬化患者植物神经功能变化。方法　以综合指标测定法测定肝硬化患者 (30例 )及对照组 (20例 )的植物神经功能。结果　在植物神经功能测定中,肝硬化组负值异常 14例,正值异常 2例,正常值 14例;对照组负值异常 3例,正值异常 5例,正常值 12例。肝硬化组与对照组相比较,肝硬化组在总体上负值异常占优势,差异有显著性(P<0. 05);植物神经功能损害与肝功能损害有相关性。结论　多数肝硬化患者植物神经功能呈现副交感神经功能增强。     

心电R－R间期频谱分析对Ⅱ型糖尿病病人心脏植物神经功能的研究

心电Ｒ－Ｒ间期频谱分析法是一种简便、无创、定量评估人体植物神经功能的方法。我们采用这一方法对２０例Ⅱ型糖尿病病人及１３例对照者的心脏植物神经功能进行了测定。结果表明：糖尿病病人存在静息卧位及体位改变后总变异的减少及体位改变后低频部分、低／高频比值不如对照组那样上升、高频部分不如对照组那样下降的现象，高频部分与病程显著相关，这些结果反映了糖尿病病人心脏植物神经功能的异常。     

功能性消化不良与心理因素及自主神经功能关系的初步研究

目的 探讨功能性消化不良（FD）与心理因素及自主神经功能之间的关系。方法 分别对20例健康人和20例FD患者进行汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和症状自评量表（SCL－90）评分，并对以上对象进行深呼吸心率差试验、立卧位心率差试验、起立血压反应试验。结果 FD患者与正常人的三种量表（HAMD、HAMA、SCL－90）评分相比，FD患者的精神（偏执除外）、躯体症状与正常人存在显著差异（P＜0.01)；FD患者与正常人的深呼吸心率差试验和立卧位心率差试验结果差异显著（P＜0.01)；而起立血压反应试验结果无显著差异。结论 FD与心理因素相关，FD患者普遍存在抑郁焦虑情绪，表现在精神和躯体两方面的症状，同时提示FD患者存在自主神经特别是迷走神经功能障碍的现象。     

The autonomic nervous system in systemic sclerosis. A review

The autonomic nervous system is an underestimated target of systemic sclerosis alterations. In this review we analyzed the major manifestations of its involvement, reconsidering the main theories of its pathogenesis.Abbreviations ANS Autonomic nervous system - BP blood pressure - BPD Basal papillary diameter - HR Heart rate - HRV Heart rate variability - MCTD Mixed connective tissue disease - PNS Peripheral nervous system - POAG Primary open-angle glaucoma - PCAG Primary closed-angle glaucoma - SSc Systemic sclerosis - SSR Sympathetic skin response     

Comparison of atrial fibrillation inducibility by electrical stimulation of either the extrinsic or the intrinsic autonomic nervous systems

Objectives  To study the effects of bilateral vagosympathetic nerve stimulation (VNS) and ganglionated plexi stimulation (GPS) on atrial refractoriness and inducibility of atrial fibrillation (AF). Methods  Studies were performed in fourteen adult mongrel dogs anesthetized with Na-pentobarbital, 30 mg/kg. VNS was achieved by insertion of wires into the left and right VN trunks. An octapolar catheter was attached to contact the right superior pulmonary vein (RSPV) and other octapolar catheter electrodes were sutured to the right atrial (RA) free wall and appendage (RAA). GPS was performed via a plaque electrode sutured to the fat pad containing the anterior right (AR) GP. VNS and GPS were matched to decrease heart rate by ∼50%. Programmed stimulation delivered from the RSPV or RAA at 2×, 4× and 10× threshold (TH) allowed the determination of atrial refractory period (ARP) and the AF inducibility. The latter was quantitated by the cumulative window of vulnerability (WOV), i.e., the longest minus the shortest coupling interval during which AF was induced at 2×, 4×, 10×, TH combined. Results  Programmed electrical stimulation at the RSPV showed that the ARP was significantly shorter for both VNS and GPS than baseline (baseline, 113 ± 22 ms; VNS, 94 ± 26 ms; GPS, 85 ± 31 ms) but there was no significant difference in ARP between VNS and GPS. In contrast, the cumulative WOV was significantly wider with GPS (39 ± 36 ms) than either the baseline state (1 ± 1 ms) or with VNS (14 ± 26 ms), p < 0.05. Moreover, pacing from RAA showed a significantly greater cumulative WOV for VNS (33 ± 36 ms) vs both baseline and GPS (1 ± 4 ms and 15 ± 26 ms, respectively, p < 0.05). The heart rate slowing caused by GPS and VNS was not significantly different, 82 ± 11/min vs 82 ± 7/min. Conclusions  These data indicate a distinct functional separation of autonomic nerve innervation to the atria from the extrinsic and intrinsic nervous systems. AF is more liable to occur due to intrinsic nerve stimulation at the PVs whereas peripheral atrial sites are more readily inducible for AF due to the extrinsic neural input. Supported, in part by grant #0650077Z from the American Heart Association (SSP), grant #K23HL069972 from the National Heart, Lung and Blood Institute (SSP) and from the Helen and Wil Webster Research Fund of the Oklahoma University Research Foundation.     

自主神经功能对糖尿病患者24小时动态血压和心率的影响

采用２４小时动态心电图和血压同步监测７５例糖尿病患者和３５例正常对照组。结果显示：随ＳＤＮＮ（２４小时内全部正常Ｒ－Ｒ间期的标准差）的降低，糖尿病患者的２４小时平均血压和心率、白昼收缩压和心率，夜间血压和心率均明显递增，昼夜血压差和心率差递减；２４小时血压波动曲线由类似双峰双谷逐渐变为失去正常节律，且夜间血压高于白昼的血压曲线；视网病变和肾病的发生率也随之增高，结论：糖尿病患者高血压的发生、发展和     

倾斜试验诱发血管迷走性晕厥56例分析

目的　探讨血管迷走性晕厥时血压,心率变化,从而了解自主神经系统所起的作用。方法　对９０ 例不明原因晕厥患者进行倾斜试验,试验过程动态监测心电图、血压和心率。结果　５６ 例发生晕厥,其中基础倾斜试验晕厥４ 例,阳性率４－４ ％ ,异丙肾上腺素倾斜试验晕厥５２ 例,阳性率５７－８％ ,其中异丙肾上腺素浓度为２ μｇ／ｍｉｎ、４ μｇ／ｍｉｎ 各２８－９％ 。晕厥时收缩压下降（４５－６６ ±２２－４６）ｍｍＨｇ,舒张压下降（２９－１１ ±１１－１４）ｍｍＨｇ,心率下降。结论　血管迷走性晕厥时血压显著下降,心率下降,提示交感神经活动减弱为主,可伴迷走神经活动增加。     

早期未治疗帕金森病患者非运动症状的特点

目的 探讨早期未治疗帕金森病(PD)患者非运动症状的分布特点和影响因素. 方法 对106例早期未治疗的PD患者及108例对照组进行非运动症状问卷调查,分析非运动症状的分布状况,并分为老年组和非老年组进行比较,其中PD老年组76例,年龄(66.8±6.6)岁,非老年组30例,年龄(57.3±5.2)岁;结合临床特征等因素分析非运动症状发生的主要影响因素. 结果 (1)老年PD组的非运动症状总数(13±7)个和非老年PD组的非运动症状总数(11±4)个,均高于同龄对照组[分别为(4±2)个和(2±1)个],差异有统计学意义(t=10.843、12.145,均P＜0.001).(2)老年PD组非运动症状发生率有20项,而非老年PD组非运动症状发生率有9项,均显著高于同龄对照组,差异有统计学意义(均P＜0.05);各项发生率中老年组以便秘、非老年组以嗅觉障碍的发生率最高.(3)老年PD组非运动症状发生个数与病程(r=0.413)、Hoehn-Yahr分级(r=0.318)和年龄(r=0.385)呈正相关(P＜0.05);非老年PD组非运动症状发生个数与Hoehn-Yahr分级呈正相关(r=0.306,P＜0.05). 结论 老年和非老年PD患者的非运动症状发生率均高于同龄对照组;非运动症状普遍存在于早期PD患者,且随着病情的加重及年龄的增长而增多;应提高对非运动症状诊断和合理治疗的重视,才能提高疗效.