COVID-19-induced gastrointestinal autonomic dysfunction:A systematic review

BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus disease 2019(COVID-19)is often reflected in the prevalence of gastrointestinal symptoms.COVID-19 can damage the nerve supply to the digestive system,leading to gastrointestinal autonomic dysfunction.There is still much to learn about how COVID-19 affects the autonomic nervous system and the gastrointestinal tract.AIM To thoroughly explore the epidemiology and clinical aspects of COVID-19-induced gastrointestinal autonomic dysfunction,including its manifestations,potential mechanisms,diagnosis,differential diagnosis,impact on quality of life,prognosis,and management and prevention strategies.METHODS We conducted a thorough systematic search across various databases and performed an extensive literature review.Our review encompassed 113 studies published in English from January 2000 to April 18,2023.RESULTS According to most of the literature,gastrointestinal autonomic dysfunction can seriously affect a patient's quality of life and ultimate prognosis.Numerous factors can influence gastrointestinal autonomic nervous functions.Studies have shown that SARS-CoV-2 has a well-documented affinity for both neural and gastrointestinal tissues,and the virus can produce various gastrointestinal symptoms by reaching neural tissues through different pathways.These symptoms include anorexia,dysgeusia,heartburn,belching,chest pain,regurgitation,vomiting,epigastric burn,diarrhea,abdominal pain,bloating,irregular bowel movements,and constipation.Diarrhea is the most prevalent symptom,followed by anorexia,nausea,vomiting,and abdominal pain.Although COVID-19 vaccination may rarely induce autonomic dysfunction and gastrointestinal symptoms,COVID-19-induced autonomic effects significantly impact the patient's condition,general health,prognosis,and quality of life.Early diagnosis and proper recognition are crucial for improving outcomes.It is important to consider the differential diagnosis,as these symptoms may be induced by diseases other than COVID-19-induced autonomic dysfunction.Treating this dysfunction can be a challenging task.CONCLUSION To ensure the best possible outcomes for COVID-19 patients,it is essential to take a multidisciplinary approach involving providing supportive care,treating the underlying infection,managing dysfunction,monitoring for complications,and offering nutritional support.Close monitoring of the patient's condition is crucial,and prompt intervention should be taken if necessary.Furthermore,conducting thorough research on the gastrointestinal autonomic dysfunction caused by COVID-19 is vital to manage it effectively.

Frequency and Associated Factors of Autonomic Dysfunction in Patients with Parkinson’s Disease in Khartoum State

Background: Autonomic dysfunction in idiopathic Parkinson disease is a frequent and disabling complication, with an estimated prevalence of 47% and has a significant impact on the patient’s quality of life. Objectives: The main objective of this study was to determine the frequency of autonomic dysfunction among Sudanese Parkinson patients and identify possible risk factors attribute to develop autonomic dysfunction and to assess the extent to which the progression of dysautonomia affects activities of daily living, health-related quality of life. Methods: In this descriptive perspective, cross-sectional hospital-based study, 51 patients were studied using standardized questionnaire including history and clinical examination. Results: A total of 51 patients have been examined: male to female ratio 1.5:1;mean age 55 ± 5 years;Parkinson disease duration, 7 ± 2 years. 47% of the patients had one or more symptoms of autonomic dysfunction with mean age 59 ± 10. Constipation and bloating were the most common symptoms where sweating abnormality was the least symptoms to observe. The symptom of autonomic dysfunction has been worse with disease progression in 50% of the patients and 47% of the patients reported that both motors and autonomic dysfunction symptoms were causing disability than autonomic dysfunction symptoms alone. Conclusions: The study demonstrates that autonomic dysfunction is not only common in Parkinson Disease, but it increases in severity with increasing disease stages. Older age with long disease duration was also considered along with advanced disease stages strong factors determining the presence of autonomic dysfunction. The study recommends that symptoms of autonomic dysfunction survey be a routine aspect of the evaluation of Parkinson disease patients, especially with advanced age.

Punicalagin prevents obesity-related cardiac dysfunction through promoting DNA demethylation in mice

The aim of this study was to investigate whether punicalagin(PU)could prevent obesity-related cardiac dysfunction by promoting DNA demethy lation,and to explore its possible mechanism.C57BL/6J mice were fed with standard diet,high-fat diet(HFD),HFD supplemented with resveratrol,low-dose PU(LPU)and high-dose PU(HPU)for 8 weeks.Compared with HFD group,body weight was significantly lower in PU treatment groups,number of cardionwocytes and the protein level of myosin heavy chain 7B were significantly higher in PU treatment groups.Levels of 5-hydroxymethylcytosine and 5-formylcytosine were significantly lower in HFD group than in other groups.Compared with the HFD group,the protein level of ten-eleven translocation enzyme(TET)2 was significantly higher in PU treatment groups,p-AMP-activated protein kinase(AMPK)was significantly higher in LPU group.Levels of total antioxidant capacity and the protein levels of complexesⅡ/Ⅲ/Ⅴ,oxoglutarate dehydrogenase,succinate dehydrogenase B and fumarate hdrolase were significantly lower in HFD group than PU treatment group.The ratio of(succinic acid+fumaric acid)/a-ketoglutarate was significantly higher in HFD group than other groups.In conclusion,PU up-regulated TETs enzyme activities and TET2 protein stability through alleviating mitochondrial dysfunction and activating AMPK,so as to promote DNA demethylation,thus preventing obesity-related cardiac dysfunction.

Abnormal Systemic and Ocular Responses to the Valsalva Manoeuvre in Primary Open-Angle Glaucoma:A Case for Autonomic Failure?

Objective This study aimed to examine the association of primary open-angle glaucoma(POAG)with autonomic dysfunction by assessing the differences in systemic and ocular responses to an autonomic provocation test,the Valsalva manoeuvre(VM),between POAG patients and normal subjects.Methods Forty POAG and forty control subjects were subjected to the VM.Systemic and ocular parameters were measured at baseline,phase 2,and phase 4 of the VM(VM2 and VM4),where VM2 and VM4 are sympathetic and parasympathetic nervous activation states,respectively.Heart rate variability was used to assess the autonomic nervous activity,among which the high-frequency component(HF)and the low-frequency(LF)/HF ratio were used as indices of parasympathetic and sympathetic activation,respectively.Results POAG patients demonstrated higher sympathetic activation(LF/HF ratio median:2.17 vs.1.53,P=0.000)than controls at baseline and exhibited attenuated sympathetic and parasympathetic responses(a smaller change in LF/HF and HF values)during the VM than controls.During VM,the intraocular pressure(IOP),mean blood pressure(MAP),mean ocular perfusion pressure(MOPP),and the Schlemm’s canal area(SCAR)increased from baseline to VM2 and then decreased from VM2 to VM4 in both the POAG and control groups(all P<0.05).However,when we compared the changes above,the fluctuations in IOP,MAP,and MOPP were more pronounced in POAG than in controls(all P<0.05),while the changes in amplitudes of SCAR were smaller in POAG(P<0.05).Furthermore,from VM2 to VM4,the choroid thickness(ChT)in the POAG group was significantly decreased,while it was unchanged in normal subjects(P=0.258).A regression analysis showed a significant correlation of the baseline LF/HF with IOP change values(ΔIOP)from baseline to VM2 in POAG(R^(2)=0.147,P=0.014).Conclusion Patients with POAG showed more pronounced fluctuations in IOP,MAP,MOPP and ChT during the VM than controls.These reactions could be associated with autonomic dysfunction in POAG.

Assessment of the autonomic nervous system is an appropriate biological marker for the well-being in erectile dysfunction

Aim： To investigate whether the autonomic nervous system （ANS） components are suitable biological markers for representing well-being in patients with erectile dysfunction （ED）. Methods： The present study included 74 male patients who had applied for check-ups in the cardiology outpatient clinic at Kirikkale University （Kirikkale, Turkey） and who had been diagnosed as having hyperlipidemia. Of these patients, 26 had an additional diagnosis of ED and made up the patient group. The remaining 48 patients formed the control group. Well-being was assessed with shortform 36 （SF-36）. The International Index of Erectile Function （IIEF） was used as a measure of libido and erectile function. Quantitative assessment of the ANS was made based on the analysis of heart rate variability by means of 24-h holter monitorization. Results： Comparisons between the ED and control groups showed significant differences only in energy scale of SF-36. The ED group also had significantly higher values of sympathetic activity. Except for the general health score of SF-36, which was found to be correlated with parasympathetic activity only in ED group, there were similar correlation patterns within the groups. Although well-being and sympathetic activity were correlated negatively, parasympathetic activity and well-being were correlated positively. Conclusion： Quantitative assessment of the ANS by heart rate variability analysis might be a suitable marker for well-being of patients with ED.

Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes?

Type 1 diabetes(T1D)is associated with general-and diabetes-specific stress which has multiple adverse effects.Hence measuring stress is of great importance.An algometer measuring pressure pain sensitivity(PPS)has been shown to correlate to certain stress measures in adults.However,it has never been investigated in children and adolescents.The aim of our study was to examine associations between PPS and glycated hemoglobin(HbA1c),salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D.Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits.Salivary cortisol,PPS and questionnaires were collected,measured,and answered on site.HbA1c was collected from medical files.We found correlations between PPS and HbA1c(rho=0.35,P=0.046),cortisol(rho=-0.25,P=0.02)and Perceived Stress Scale(rho=-0.44,P=0.02)in different subgroups based on age.Males scored higher in PPS than females(P<0.001).We found PPS to be correlated to HbA1c but otherwise inconsistent in results.High PPS values indicated either measurement difficulties or hypersensibility towards pain.

昼夜节律紊乱导致自主神经功能失衡的研究进展

自主神经功能保持平衡对维持机体功能至关重要,昼夜节律系统参与了自主神经系统功能调节。昼夜节律紊乱会引起交感神经活性增加、迷走神经活性降低,进而促进心血管疾病发生和发展。然而,昼夜节律紊乱导致自主神经功能失衡的机制尚未明确。本文以昼夜节律对自主神经功能的影响为出发点,旨在明确昼夜节律紊乱导致自主神经功能失衡的可能机制,并归纳了褪黑素治疗、光线调节、运动疗法、迷走神经刺激等防治措施。

糖尿病与非糖尿病血液透析患者心脏自主神经的功能变化

目的:通过分析血液透析(HD)开始至透析后24 h(共28 h)的心率变异性(HRV),探究糖尿病与非糖尿病的维持性血液透析(MHD)患者不同时段心脏自主神经功能的差异及变化,为改善患者心脏事件的发生提供依据。方法:选取2021-10-01~2022-12-31在北京大学人民医院HD中心行MHD的患者,心电记录在HD开始时采集,持续至少28 h。比较两组患者在HD开始后1 h、2 h、3 h、4 h、5 h、28 h的HRV参数。结果:共纳入MHD患者110例,其中糖尿病患者36例(32.73%)。糖尿病组冠心病比例较高、透析龄较短、单室尿素清除指数(spKt/V)较低。在透析过程中糖尿病组全部窦性心搏RR间期的标准差(SDNN)和低频(LF)持续低于非糖尿病患者(P<0.05),非糖尿病患者RR间期差值的均方根(RMSSD)呈逐渐升高趋势,两组在HD开始1 h后出现明显差异。HD间期,糖尿病患者透析后1 h SDNN及LF明显高于非糖尿病患者,HD后24 h两组间各心率变异性参数无统计学差异。非糖尿病患者HD后24 h HRV明显下降。结论:糖尿病对MHD患者的心脏自主神经功能影响超过了尿毒症背景。非糖尿病MHD患者心脏自主神经功能优于糖尿病患者。

针灸关元穴治疗男性勃起功能障碍的作用机制研究

关元穴是目前泌尿生殖系统领域研究最为广泛的腧穴之一,也是在阴茎勃起功能障碍治疗中应用频率最高的穴位之一。针刺关元穴后,通过躯体-自主神经反射、细胞神经间突触样连接,传递生物化学信号,调控平滑肌细胞及血管内皮细胞,促使阴茎血管壁扩张、血流量增加和阴茎海绵体充血胀大;同时进一步沿着脊髓、脑水平传递神经冲动,提高中枢兴奋性。针灸通过调节下丘脑-垂体-性腺轴,促进促性腺激素释放、促黄体生成素及性激素的释放,调节性功能紊乱,还可以通过调控下丘脑-垂体-肾上腺轴来改善焦虑、抑郁情绪。此外,还可通过增强盆底肌力量、提高盆底肌肉本体感觉,改善勃起功能。然而,针刺关元穴兴奋男性阴茎勃起功能效应相关的分子生物学机制仍有待进一步完善。

转甲状腺素蛋白淀粉样变性多发性神经病1例诊治体会

转甲状腺素蛋白淀粉样变性多发性神经病(transthyretin amyloid polyneuropathy,ATTR-PN)是由编码转甲状腺素蛋白的TTR基因致病变异导致的一种以周围神经损害为主,呈常染色体显性遗传的多系统疾病。本文报道1例ATTR-PN,希望提高临床医生对此病的认识,减少误诊率。

儿童青少年家庭功能障碍与心理健康关系的三水平元分析

当家庭无法完成相应任务或家庭不具备良好的特征时,即为家庭功能障碍。家庭功能障碍是影响儿童青少年心理健康的重要因素,但两者关系存在争议。为了较为全面地理解家庭功能障碍(主观与客观)与儿童青少年心理健康(积极与消极)的关系,基于家庭系统理论和心理健康双因素模型,采用三水平元分析对两者关系进行探讨。检索和筛选2022年3月1日以前发表的文献,最终纳入97项研究,包括173个效应量和130227名被试。主效应检验发现,单亲通过损害积极心理健康状态、加剧消极心理健康状态影响儿童青少年,父母离异、父母服刑、父母物质滥用、父母患精神疾病、主观家庭功能障碍通过加剧消极心理健康状态影响儿童青少年。调节效应检验发现,单亲对男生心理健康的消极影响更大;集体主义背景下,父母服刑对儿童青少年心理健康的消极影响更大。研究结果不仅支持家庭系统理论,还提示需要给予家庭功能障碍儿童青少年的积极心理健康状态更多关注,并在关注文化背景的同时,根据性别差异进行精准干预。

基于“阳化气,阴成形”辨治冠状动脉粥样硬化性心脏病自主神经功能紊乱

阴阳是中国古代哲学思想的重要组成部分,也是中医理论中的核心内容。阴阳者,世间万物化生繁衍之根本也,两者之间既对立制约又互根互用,维系着人体物质与能量的相互转换,人体气血津液的正常运行、五脏气血的调和,皆离不开阴阳之相互作用,阴平阳秘,精神乃治;阴阳失调,百病始生。中医以阴阳为基础阐释并演绎人体的生理功能与病证规律,强调阴阳平衡之重要性,并以此来指导临床疾病的诊断与治疗。“阳化气,阴成形”是气化的两个过程,两者之间联系紧密,伴随着人体生命活动的始终,概括了人体阳气和阴精的主要功能,也诠释了人体生长壮老已的自然规律。支配心脏的自主神经同样具有阴阳两种属性,其中,交感神经其性属阳,用于能量的释放,副交感神经其性属阴,用于能量的储存,正常情况下,两者之间平衡协调、相互制约,共同调节心脏,使之正常活动,若该平衡受到破坏,则易引发心脏自主神经功能紊乱,从而导致心血管疾病的发生。其中,冠状动脉粥样硬化性心脏病自主神经功能紊乱乃阳化气失调,致使阴成形失常,病邪阻于胸中,进而使胸中气血不畅所致。文章基于“阳化气,阴成形”理论探讨冠状动脉粥样硬化性心脏病自主神经功能紊乱的辨治方法,提出以扶阳、养阴为基本治疗原则,以期为临床冠状动脉粥样硬化性心脏病的治疗提供帮助。

逍遥丸与草酸艾司西酞普兰联用对PVC伴抑郁障碍患者的影响

目的探讨采取逍遥丸联合草酸艾司西酞普兰治疗频发性室性期前收缩(PVC)伴抑郁障碍的效果。方法选取100例研究对象,分为试验组与对照组,各50例。2组均给予常规治疗,对照组在常规治疗基础上给予草酸艾司西酞普兰,试验组在对照组基础上加用逍遥丸治疗,8周后,观察治疗效果。结果2组治疗后日间与夜间PVC发作次数、二联律百分比、三联律百分比均较治疗前降低,且试验组低于对照组(P<0.05);治疗后2组患者rMSSD、SDNN、SDNN5、SDANN均较治疗前提高,试验组高于对照组(P<0.05);治疗后2组HAMD评分较治疗前降低,试验组低于对照组(P<0.05)。结论对频发性PVC伴抑郁障碍,使用逍遥丸联合草酸艾司西酞普兰的治疗方式,可改善患者病情及自主神经功能紊乱,缓解抑郁症状,值得推广。

河南长垣张氏中医内科学术流派传承与临证经验

作为河南省首批优质中医学术流派,河南长垣张氏中医内科流派传承脉络清晰,学术思想鲜明,临床经验丰富,是中原医学流派的重要代表之一。该流派创立者张清连在地域文化影响下,传承家学,儒医兼通,擅长运用中医药诊治肺病、脾胃病、痹证、男科疾病等中医内科疾病。第二代传承人张超然主张为医重在治病救人,除精通家传医学外,在中医外科、妇科、儿科方面也多有创新和突破。第三代传承人张华甫为豫北名老中医,从事中医临床工作60余年,临证注重从天人合一、形神合一的整体观念入手,强调三因制宜和四诊合参,擅长诊治中医内科疑难杂病,尤其在脾胃病和肝胆病的辨证论治方面具有独特的学术见解和丰富的临床经验;张庆瑞擅长治疗中医妇科和内科杂病,对肝病和神智疾患有所研究,注重培补脾胃,顾全正气。第四代传承人张景祖为河南省名中医,擅长运用中医药诊治肺病、脾胃病、痹证、男科疾病、肾病、糖尿病、脑病等疑难杂症,致力于清肺平喘丸、补肾生精丸等流派代表经验方,胃肠病中医疗法、痹证中医疗法等流派特色疗法的临床运用和研究;张昱在继承家学基础之上,师从国医大师王绵之等中医名家,擅长运用传统中医药或中西医结合的方法治疗急慢性肾炎、肾病综合征、慢性肾功能衰竭、糖尿病肾病、痛风性肾病、高血压性肾损害、紫癜性肾炎、狼疮性肾炎等各类肾脏疾病。

Cardiac autonomic neuropathy in patients with diabetes mellitus

Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.

Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury

Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons （SPNs） caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per- formance, which holds promise as a potential therapeutic approach.

Activities of autonomic neurotransmitters in meibomian gland tissues are associated with menopausal dry eye

The secretory activities of meibomian glands are regulated by the autonomic nervous system, The change in density and activity of autonomic nerves in meibomian glands during menopause play an important role in the pathogenesis of dry eye. In view of this, we established a dry eye rat model by removing the bilateral ovaries. We used neuropeptide Y and vasoactive intestinal polypeptide as markers of autonomic neurotransmitters. Our results showed that the concentration of estradiol in serum significantly decreased, the density of neuropeptide Y immunoreactivity in nerve fibers significantly increased, the density of vasoactive intestinal polypeptide immunoreactivity in nerve fibers significantly decreased, and the ratio of vasoactive intestinal polypeptide/neuropeptide Y positive staining significantly decreased. These results suggest that a decrease in ovary activity may lead to autonomic nervous system dysfunction, thereby affecting the secretory activity of the meibomian gland, which participates in sexual hormone imbalance-induced dry eye.

Analysis of the Autonomic Regulation in a Case of Facioscapulohumeral Muscular Dystrophy after Ken Ware Treatment

This is a study on autonomic neuroscience. In a previous paper in?[1], we studied a subject affected from facioscapulohumeral muscular dystrophy before and after Ken Ware treatment (NPT). Using the non linear methodology of the Generalized Mutual Information (GMI) analysis of Sensory Motor Rhythm, we produced detailed results evidencing that the mentioned NPT treatment involved a net improvement of the patient under his subjective psychological condition, and in particular, under the neurological and sensory motor profile. We quantified with accuracy the improvement that the subject realized during such treatment. Of course, previous studies of several authors?have evidenced that muscular dystrophies are strongly linked to a profound ANS disfunction.Therefore, the aim of the present study was to analyze the ANS of the subject before and after the treatment. We performed analysis in time as well as in frequency domain and by using non linear?methods. The basic result of the paper was that, according to our analysis, the subjects started?with a serious ANS disfunction before the NPT treatment and that a net improvement was obtained after this therapy. All the examined parameters resulted strongly altered before the treatment and all they returned in the normal range after the NPT.

Vitamin D Status, Autonomic Nervous System Activity, and Cardiometabolic Risk

Vitamin D and its association with cardiovascular disease (CVD) are currently a topic of investigation. The objective of this study was to explore the association between vitamin D status (serum 25-hydroxyvitamin D (25(OH)D)) and a cardiometabolic risk score (CMRS) derived from markers of cardiac autonomic nervous system activity, vascular dynamics, and body composition, using an innovative non-invasive technology. We found that individuals who were vitamin D sufficient ((25(OH)D) ≥ 30 ng/ml, n = 51), compared to those who were vitamin D insufficient (<30 ng/ml, n = 44), had significantly higher heart rate variability (as measured by time and frequency domain variables) and lower photoplethysmography analysis markers and CMRS. These outcomes show that vitamin D insufficient subjects had reduced cardio protective parasympathetic nervous system activity, increased endothelial dysfunction, and hence were at greater cardiometabolic risk, implying vitamin D may play a meaningful role in CVD.

中医辨证治疗早期帕金森病自主神经功能障碍临床研究

目的观察中医辨证治疗早期帕金森病(PD)自主神经功能障碍的临床疗效。方法纳入292例早期PD患者,采用随机、双盲、安慰剂、多中心对照原则,通过SAS软件产生4种中医证型的区组随机分配表,中药组和对照组按照1∶1比例分组。2组均予左旋多巴(LD)基础治疗。中药组根据气血不足型、气滞血瘀型、痰热动风型、肝肾不足型分别予黄芪平颤颗粒、逐瘀平颤颗粒、涤痰平颤颗粒、熟地平颤颗粒,对照组予相应证型安慰剂颗粒,疗程均为24周,12周随访1次。观察自主神经症状量表(SCOPA-AUT)和帕金森病综合评分量表(UPDRS)Ⅱ、Ⅲ评分及LD用量,评价2组及中药组不同证型的有效性及安全性。结果最终完成258例,2组各129例。中药组治疗后SCOPA-AUT及UPDRSⅡ、Ⅲ评分明显低于对照组(P<0.01),其中胃肠道症状、心血管症状评分明显优于对照组(P<0.05,P<0.01)。中药组气滞血瘀型和肝肾不足型治疗后SCOPA-AUT总分优于对照组(P<0.05),其中气滞血瘀型胃肠道症状、心血管症状评分优于对照组(P<0.05),气血不足型泌尿道症状评分优于对照组(P<0.05),肝肾不足型胃肠道症状评分优于对照组(P<0.05)。2组不良事件发生率比较差异无统计学意义(P>0.05)。结论中医辨证施治可有效改善早期PD患者自主神经各项功能障碍,不同证型患者自主神经症状均有不同程度改善,且不良反应少。