青少年特发性脊柱侧凸交感神经系统活性左右侧对称性的观察

The asymmetry of the activity of sympathetic nervous system in the patients with adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  交感神经系统  交感神经皮肤反应

英文关键词:Adolescent idiopathic scoliosis  Sympathetic nervous system  Sympathetic skin response

中文摘要:

  【摘要】 目的：探讨交感神经系统（sympathetic nervous system，SNS）活性在AIS病因学中可能存在的作用。方法：前瞻性研究。纳入68例右胸弯AIS女性患者为观察对象，年龄11~18岁，平均14.2±2.4岁；主弯Cobb角11°~64°，平均37.2°±13.5°。选取5例青少年先天性脊柱侧凸（CS）女性患者和28例正常年轻女性作为对照，CS患者年龄12~18岁，平均14.7±3.1岁；正常年轻女性11~22岁，平均17.9±4.0岁。采用交感神经皮肤反应（sympathetic skin response，SSR）评估3组的SNS活性，以上下肢潜伏期和振幅右侧/左侧的比值作为评估指标。组间及组内比较采用独立样本t检验，P<0.05为差异有统计学意义。结果：正常年轻女性组中，上下肢潜伏期和振幅右/左比值在正常青少年（13.6±2.8岁，11~17岁）和年轻女性（20.7±1.2岁，19~22岁）间无显著性差异 （P>0.05）。女性AIS患者上肢潜伏期右侧/左侧比值（1.01±0.05）显著性大于正常年轻女性（0.98±0.04，P=0.036），上肢振幅、下肢潜伏期和下肢振幅右侧/左侧比值在女性AIS患者与正常年轻女性间无显著性差异（P>0.05）。CS患者上、下肢潜伏期和振幅的右侧/左侧比值与正常年轻女性间无显著性差异（P>0.05）；女性AIS患者上、下肢潜伏期和振幅右侧/左侧比值在小角度（<40°）和大角度（≥40°）间亦无显著性差异（P>0.05）。结论：女性AIS患者身体两侧SNS活性存在不对称性，其可能与发病有关，但是与侧凸的严重程度无显著相关性。

英文摘要:

  【Abstract】 Objectives: To explore the probable associations of the sympathetic nervous system(SNS) activity with the etiology in adolescent idiopathic scoliosis(AIS). Methods: A prospective study including 68 right thoracic AIS female patients, 5 congenital scoliosis(CS) and 28 healthy girls with a mean age of 14.2±2.4y(11-18y), 14.7±3.1y(12-18y) and 17.9±4.0y(11-22y), respectively was carried out. The mean Cobb angle of major curve in AIS was 37.2°±13.5°(11°-64°). The asymmetry of SNS activity was presented by the right/left(R/L) ratios of latency and the amplitude of sympathetic skin response(SSR) obtained in upper and lower limbs. Student′s t test was used in inter- and intra-group comparisons. A statistically significant difference was defined by P<0.05. Results: In the normal control group, there was no significant difference in the L/R ratios of latency and amplitude of SSR in upper and lower limbs between adolescents(13.6±2.8y, 11-17y) and young adults(20.7±1.2y, 19-22y)(P>0.05). The R/L ratios of the latency in AIS upper limbs(1.01±0.05) were significantly greater than those in normal controls(0.98±0.04, P=0.036), which indicated that the symmetry of the SNS activities in AIS was significantly different from that in normal controls; while there were no significant differences in the R/L ratios of the upper limb amplitude, lower limb latency and lower limb amplitude between AIS and normal controls(P>0.05). Moreover, there was no significant difference in the R/L ratios of the latency and amplitude between normal controls and CS(P>0.05); meanwhile, no significant difference was found in the R/L ratios of latency and the amplitude between AIS patients with mild curve(<40°) and those with great curve(≥40°)(P>0.05), which showed no significant association between the curve severity and the abonormality of SNS activity in AIS. Conclusions: The asymmetry of SNS activity in AIS female patients is significantly different from that in normal controls, which indicates a probable involvement of the abnormality of the SNS activity in the etiology of AIS, but is not associated with the severity