目的:本研究旨在通过评估对自主神经激发试验的全身和眼部反应的差异,来检查原发性开角型青光眼(POAG)与自主神经功能障碍的关系。瓦尔萨尔瓦演习(VM),POAG患者和正常人之间。
方法:对40名POAG和40名对照受试者进行VM。在基线测量系统和眼部参数,虚拟机的阶段2和阶段4(VM2和VM4),其中VM2和VM4是交感神经和副交感神经激活状态,分别。心率变异性用于评估自主神经活动,其中高频分量(HF)和低频(LF)/HF比率被用作副交感神经和交感神经激活的指标,分别。
结果:POAG患者表现出更高的交感神经激活(LF/HF比率中位数:2.17vs.1.53,P=0.000)在基线时比对照组表现出减弱的交感神经和副交感神经反应(LF/HF和HF值的变化较小)。在VM期间,眼内压(IOP),平均血压(MAP),平均眼灌注压(MOPP),POAG组和对照组的Schlemm管区面积(SCAR)从基线增加到VM2,然后从VM2减少到VM4(均P<0.05)。然而,当我们比较上面的变化时,IOP的波动,MAP,POAG和MOPP比对照组更明显(均P<0.05),POAG中SCAR的幅度变化较小(P<0.05)。此外,从VM2到VM4,POAG组的脉络膜厚度(ChT)明显下降,而在正常人中没有变化(P=0.258)。回归分析显示,基线LF/HF与POAG中从基线到VM2的IOP变化值(ΔIOP)显着相关(R2=0.147,P=0.014)。
结论:POAG患者眼压波动更明显,MAP,在VM比控制期间的MOPP和ChT。这些反应可能与POAG的自主神经功能障碍有关。
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 (R2=0.147, P=0.014).
CONCLUSIONS: 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.