Calf venous compliance in multiple system atrophy.
Calf venous compliance in multiple system atrophy.
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小腿静脉顺应性多系统萎缩。
DOI：
10.1152/ajpheart.01208.2006
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Low,PA
中科院分区：
文献类型：
--
作者：
Lipp,A;Sandroni,P;Ahlskog,JEric;Maraganore,DM;Shults,CW;Low,PA
在多系统萎缩（MSA）中，静脉顺应性增加伴静脉过度汇集被认为是体位性低血压（OH）的主要原因;然而，从未在MSA患者中评估静脉顺应性。我们评估了11例可能患有MSA的患者、14例年龄和性别匹配的对照组和8例帕金森病（PD）但非OH患者的肾上腺素能、心迷走神经和催汗功能衰竭的严重程度和分布。小牛静脉顺应性，静脉充盈，毛细血管滤过用小腿体积描记法测量。另外评价了直接作用的α-肾上腺素能刺激（10 mg米多君）对小牛静脉顺应性的反应。与我们的假设相反，MSA患者腿部的压力-容积曲线比PD患者（P< 0.05）或对照组（P< 0.001）更平坦;这表明MSA患者的小腿静脉顺应性降低。与对照组（P< 0.001）或PD受试者（P< 0.001）相比，MSA组的静脉充盈减少，但毛细血管滤过率正常（P= 0.73）。直接α-肾上腺素能刺激导致对照组（P= 0.001）和PD受试者（P< 0.001）的小腿静脉顺应性轻微但显著降低，但MSA组没有。自主神经功能衰竭（复合自主神经严重程度量表，r2= 0.56），但不与帕金森病（统一MSA评定量表，r2= 0.12）的MSA的依从性变化显着回归。我们的数据表明，MSA患者慢性OH的小腿静脉顺应性降低，而不是增加。我们推测，慢性静脉扩张与OH的结果在静脉结构重塑，导致顺应性降低，这可能会保护患者对直立性压力的变化。
In multiple system atrophy (MSA), increased venous compliance with excessive venous pooling is assumed to be a major contributor to orthostatic hypotension (OH); however, venous compliance has never been assessed in MSA patients. We evaluated the severity and distribution of adrenergic, cardiovagal, and sudomotor failure in 11 patients with probable MSA, 14 age- and sex-matched control subjects, and 8 patients with Parkinson's disease (PD) but not OH. Calf venous compliance, venous filling, and capillary filtration were measured using calf plethysmography. The response to the directly acting α-adrenergic stimulation (10 mg midodrine) on calf venous compliance was additionally evaluated. Contrary to our hypothesis, pressure-volume curves in the legs of MSA patients were flatter than in PD patients (P< 0.05) or controls (P< 0.001); this indicated reduced calf venous compliance in MSA. The MSA group had reduced venous filling compared with control (P< 0.001) or PD subjects (P< 0.001) but had a normal capillary filtration rate (P= 0.73). Direct α-adrenergic stimulation resulted in a slight but significant reduction of calf venous compliance in controls (P= 0.001) and PD subjects (P< 0.001) but not in the MSA group. The compliance change in MSA significantly regressed with autonomic failure (composite autonomic severity scale,r2= 0.56) but not with parkinsonism (Unified MSA Rating Scale,r2= 0.12). Our data indicate that MSA patients with chronic OH have reduced, rather than increased, venous compliance in the lower leg. We postulate that chronic venous distension that is associated with OH results in structural remodeling of veins, leading to reduced compliance, a change which may protect patients against orthostatic stress.