PDF(Pubmed)
Abstract：
Background: There have been previous reports of enhanced sympathoexcitation in autism spectrum disorder (ASD). However, there has been no formal investigation of autonomic dysfunction in ASD. Also, the joint hypermobile form of Ehlers-Danlos syndrome (hE-DS) that maybe overrepresented in ASD and orthostatic related autonomic dysfunction. This study examined the comorbidity of ASD, autonomic dysfunction and hE-DS in two UK autonomic national referral centers. Proven, documented and globally accepted clinical autonomic investigations were used to assess neuro-cardiovascular autonomic function in a cohort of ASD subjects and in age-matched healthy controls. Methods: Clinical data from 28 referrals with a confirmed diagnosis of ASD over a 10-year period were compared with 19 age-matched healthy controls. Autonomic function was determined using methods established in the centers previously described in detail. Results: 20/28 ASD had a diagnosed autonomic condition; 9 had the postural tachycardia syndrome (PoTS), 4 PoTS and vasovagal syncope (VVS), 3 experienced presyncope, 1 essential hyperhidrosis, 1 orthostatic hypotension, 1 VVS alone and 1 a combination of PoTS, VVS and essential hyperhidrosis. 16/20 ASD with autonomic dysfunction had hE-DS. In ASD, basal heart rate and responses to orthostatic tests of autonomic function were elevated, supporting previous findings of increased sympathoexcitation. However, sympathetic vasoconstriction was impaired in ASD. Conclusion: Intermittent neuro-cardiovascular autonomic dysfunction affecting heart rate and blood pressure was over-represented in ASD. There is a strong association with hE-DS. Autonomic dysfunction may further impair quality of life in ASD, particularly in those unable to adequately express their experience of autonomic symptoms.
摘要：
背景：以前有自闭症谱系障碍（ASD）的交感神经兴奋增强的报道。然而,尚未对ASD的自主神经功能障碍进行正式调查。此外，Ehlers-Danlos综合征（hE-DS）的联合过度活动形式，在ASD和直立相关的自主神经功能障碍中可能过多。这项研究检查了ASD的合并症，英国两个自主国家转诊中心的自主神经功能障碍和hE-DS。经证明,在ASD受试者队列和年龄匹配的健康对照人群中,采用有记录且全球公认的临床自主神经研究评估神经-心血管自主神经功能.方法：将10年内确诊为ASD的28例转诊患者的临床数据与19例年龄匹配的健康对照进行比较。使用先前详细描述的中心中建立的方法确定自主功能。结果：20/28ASD诊断为自主神经疾病；9人患有体位性心动过速综合征（PoTS），4点和血管迷走性晕厥（VVS），3个有经验的晕厥前，1原发性多汗症，1直立性低血压，1个单独的VVS和1个PoTS的组合，VVS和原发性多汗症。16/20ASD伴自主神经功能障碍有hE-DS。在ASD,基础心率和自主功能体位试验的反应升高，支持先前关于交感神经兴奋增加的发现。然而,ASD患者交感神经血管收缩受损。结论：影响心率和血压的间歇性神经-心血管自主神经功能障碍在ASD中的表现过高。与hE-DS有很强的关联。自主神经功能障碍可能进一步损害ASD的生活质量，尤其是那些无法充分表达其自主神经症状的人。
