青少年特发性脊柱侧凸交感神经系统活性左右侧对称性的观察

The asymmetry of the activity of sympathetic nervous system in the patients with adolescent idiopathic scoliosis

目的:探讨交感神经系统(sympathetic nervous system,SNS)活性在AIS病因学中可能存在的作用。方法:前瞻性研究。纳入68例右胸弯AIS女性患者为观察对象,年龄11~18岁,平均14.2±2.4岁;主弯Cobb角11°~64°,平均37.2°±13.5°。选取5例青少年先天性脊柱侧凸(CS)女性患者和28例正常年轻女性作为对照,CS患者年龄12~18岁,平均14.7±3.1岁;正常年轻女性11~22岁,平均17.9±4.0岁。采用交感神经皮肤反应(sympathetic skin response,SSR)评估3组的SNS活性,以上下肢潜伏期和振幅右侧/左侧的比值作为评估指标。组间及组内比较采用独立样本t检验,P<0.05为差异有统计学意义。结果:正常年轻女性组中,上下肢潜伏期和振幅右/左比值在正常青少年(13.6±2.8岁,11~17岁)和年轻女性(20.7±1.2岁,19~22岁)间无显著性差异(P>0.05)。女性AIS患者上肢潜伏期右侧/左侧比值(1.01±0.05)显著性大于正常年轻女性(0.98±0.04,P=0.036),上肢振幅、下肢潜伏期和下肢振幅右侧/左侧比值在女性AIS患者与正常年轻女性间无显著性差异(P>0.05)。CS患者上、下肢潜伏期和振幅的右侧/左侧比值与正常年轻女性间无显著性差异(P>0.05);女性AIS患者上、下肢潜伏期和振幅右侧/左侧比值在小角度(<40°)和大角度(≥40°)间亦无显著性差异(P>0.05)。结论:女性AIS患者身体两侧SNS活性存在不对称性,其可能与发病有关,但是与侧凸的严重程度无显著相关性。

Objectives： To explore the probable associations of the sympathetic nervous system（SNS） activity with the etiology in adolescent idiopathic scoliosis （AIS）. Methods： A prospective study including 68 right thoracic AIS female patients, 5 congenital scoliosis （CS） and 28 healthy girls with a mean age of 14.2＋2.4y （ll-18y）, 14.7_＋3.1y（12-18y） and 17.9_＋4.0y（ll-22y）, respectively was carried out. The mean Cobb angle of major curve in AIS was 37.2~＋13.5^（11^-64^）. The asymmetry of SNS activity was presented by the fight/left （R/L） ratios of latency and the amplitude of sympathetic skin response （SSR） obtained in upper and lower limbs. Student＇s t test was used in inter- and intra-group comparisons. A statistically significant difference was defined by P〈0.05. Results： In the normal control group, there was no significant difference in the L/R ratios of latency and amplitude of SSR in upper and lower limbs between adolescents（13.6＋2.8y, l l-17y） and young adults（20.7~l.2y, 19-22y）（P〉O.05）. The R/L ratios of the latency in AIS upper limbs（1.01_＋0.05） were significantly greater than those in normal controls（0.98_＋0.04, P=0.036）, which indicated that the symmetry of the SNS activities in AIS was significantly different from that in normal controls; while there were no significant differences in the R/L ratios of the upper limb amplitude, lower limb latency and lower limb amplitude between AIS and normal controls（P〉0.05）. Moreover, there was no significant difference in the R/L ratios of the latency and amplitude between normal controls and CS （P〉0.05）; meanwhile,