帕金森病患者颈部迷走神经横截面面积与心血管自主神经功能障碍的关系

Relationship between cervical vagus nerve cross-sectional area and cardiovascular autonomic nerve dysfunction in Parkinson's disease patients

目的 观察帕金森病(PD)患者颈部迷走神经横截面面积(CAS)变化,探讨其与心血管自主神经功能障碍的关系。方法 2019年10月—2022年10月河南省人民医院诊治PD患者45例为PD组,记录PD患者入院时帕金森病评定量表Ⅲ(UPDRS-Ⅲ)评分、Hoehn-Yahr(H-Y)分级。同期体检健康者45例为对照组。PD组于入院日、对照组于体检日采用PD自主神经症状量表(SCOPA-AUT)评估自主神经功能,记录SCOPA-AUT心血管评分;行颈部超声检查,测量左右侧颈部迷走神经CAS;行24 h动态心电图检查分析心率变异率,记录全部正常R-R间期标准差(SDNN)、全部相邻R-R间期差值的均方根(rMSSD)、高频功率(HF)、低频功率(LF)。比较2组性别、年龄、体质量指数、SCOPA-AUT总分、SCOPA-AUT心血管评分、颈部迷走神经CAS及SDNN、rMSSD、HF、LF;Pearson相关法分析PD患者左右侧颈部迷走神经CAS与PD病程、UPDRS-Ⅲ评分、H-Y分级、SCOPA-AUT评分、SCOPA-AUT心血管评分的相关性,右侧颈部迷走神经CAS与SDNN、rMSSD、HF、LF的相关性。结果 (1)PD组性别比例、年龄、体质量指数与对照组比较差异均无统计学意义(P>0.05)。PD组SCOPA-AUT总分[(16.22±5.21)分]、SCOPA-AUT心血管评分[(3.40±1.68)分]均高于对照组[(3.12±1.78)、(1.05±0.77)分](t=15.147,P<0.001;t=8.496,P<0.001)。(2)PD组左、右侧颈部迷走神经CAS[(2.77±0.66)、(3.02±0.77)mm~2]均小于对照组[(3.37±0.65)、(3.67±0.88)mm~2](P<0.01)。2组右侧颈部迷走神经CAS均大于左侧(P<0.05)。(3)PD组SDNN[(131.63±21.38)ms]、rMSSD[(20.86±4.52)ms]、HF[(827.89±167.5)Hz]均低于对照组[(142.98±19.95)ms、(28.40±3.65)ms、(914.33±99.52)Hz](P<0.05),LF与对照组比较差异无统计学意义(P>0.05)。(4)PD患者UPDRS-Ⅲ评分为(26.19±14.53)分、H-Y分级为(2.51±0.78)级。PD患者右侧颈部迷走神经CAS与H-Y分级(r=-0.343,P=0.023)、SCOPA-AUT总分(r=-0.415,P=0.006)、SCOPA-AUT心血管评分(r=-0.448,P=0.002)均呈负相关,与rMSSD(r=0.318,P=0.040)、HF(r=0.409,P=0.006)均呈正相关。结论 PD患者双侧迷走神经CAS缩小,右侧迷走神经CAS越小心血管自主神经功能受损越重,右侧迷走神经CAS可作为量化PD患者心血管自主功能障碍的指标。

Objective To observe the variation of cervical vagus nerve cross-sectional area(CAS) in patients with Parkinson's disease(PD),and to investigate the relationship between CAS and cardiovascular autonomic nerve dysfunction.Methods Forty-five patients with PD(PD group) received Parkinson's Disease Rating Scale Ⅲ(UPDRS-Ⅲ)scoring and Hoehn-Yahr(H-Y) grading in Henan Provincial People's Hospital from October 2019 to October 2022.Another 45 healthy individuals who underwent health examination during the same period were as controls(control group).The autonomic nerve function was evaluated by Scale for Outcomes in Parkinson's Disease-Autonomic symptoms(SCOPA-AUT) in PD group on admission and in control group on the day of health examination to record cardiovascular SCOPA-AUT score,and cervical ultrasonography was done to measure the left and right cervical vagus nerve CASs.The24-h Holter electrocardiography was performed to monitor the heart rate variability and to record the standard deviation normal R-R interval(SDNN),root mean square of successive R-R interval differences(rMSSD),high frequency power(HF) and low frequency power(LF).The gender,age,body mass index,SCOPA-AUT score,cardiovascular SCOPA-AUT score,cervical vagus nerve CAS,SDNN,rMSSD,HF and LF were compared between two groups.Pearson correlation method was used to analyze the correlations of left and right cervical vagus nerve CASs with PD disease course,UPDRS-Ⅲ score,H-Y grade,SCOPA-AUT score and cardiovascular SCOPA-AUT score,and the correlations of right cervical vagus nerve CAS with SDNN,rMSSD,HF and LF in PD patients.Results(1) The SCOPA-AUT score and cardiovascular SCOPA-AUT score were higher in PD group(16.22±5.21,3.40±1.68) than those in control group(3.12±1.78,1.05±0.77)(t=15.147,P<0.001;t=8.496,P<0.001),and there were no significant differences in the gender ratio,age and body mass index between two groups(P>0.05).(2) The left and right cervical vagus nerve CASs were smaller in PD group [(2.77±0.66),(3.02±0.77) mm~2] than those in control group [(3.37±0.65),(3.67±0.88) mm~2](P<0.01),and the CASs of right cervical vagus nerve were larger than those of left one in both groups(P<0.05).(3) The SDNN,rMSSD and HF were lower in PD group [(131.63±21.38) ms,(20.86±4.52) ms,(827.89±167.5) Hz] than those in control group [(142.98±19.95) ms,(28.40±3.65) ms,(914.33±99.52) Hz](P<0.05),and the LF showed no significant difference between two groups(P>0.05),(4) The UPDRS-Ⅲ score and H-Y grade were 26.19±14.53 and 2.51±0.78 in PD patients.The CAS of the right cervical vagus nerve was negatively correlated with H-Y grade(r=-0.343,P=0.023),SCOPA-AUT score(r=-0.415,P=0.006) and cardiovascular COPA-AUT score(r=-0.448,P=0.002),and was positively correlated with rMSSD(r=0.318,P=0.040) and HF(r=0.409,P=0.006).Conclusions Bilateral cervical vagus nerve CASs decrease in PD patients.The smaller the right cervical vagus nerve CAS,the severer the cardiovascular autonomic nerve dysfunction.The right cervical vagus nerve CAS could be used as an indicator to quantify cardiovascular autonomic nerve dysfunction in PD patients.