The Value Of Cardiovascular Autonomic Nervous Dysfunction In The Differential Diagnosis Of Multiple System Atrophy And Parkinson’s Disease

Background and objectivemultiple system atrophy(MSA)and Parkinson’s disease(PD)are neurodegenerative diseases characterized by abnormal accumulation of insolubleα-synuclein.Cardiovascular autonomic nervous dysfunction is common in patients with PD and MSA.Sometimes it even appears as the first symptom,which brings great challenges to the early differential diagnosis of MSA and PD,and has a serious impact on the quality of life and prognosis of the patients.Therefore,we need some detection indicators which are easy to operate and can be widely used in clinic for early identification and differential diagnosis of cardiovascular autonomic nervous dysfunction in MSA and PD.In this study,24-hour ambulatory blood pressure monitoring(24-h ABPM),heart rate variability(HRV)and head-up tilt test(HUTT)were used to evaluate the characteristics of cardiovascular autonomic nervous dysfunction in MSA and PD.It arms to explore the differential diagnostic value of the three auxiliary examinations,and to provide a new idea for the early diagnosis and treatment of MSA and PD.MethodsA total of 135 patients with MSA,161 patients with PD and 140 healthy persons matched in age and sex were selected as the control group in the First Affiliated Hospital of Zhengzhou University from January 2017 to January 2021 were adopted in this study.The patients in the three groups were examined by 24h-ABPM and HRV at the same time,of which 85 patients with MSA and 80 patients with PD were performed by HUTT.According to the clinical symptoms of MSA patients,MSA was divided into MSA-C type with cerebellar ataxia and MSA-P type with Parkinson’s symptoms.And the patients with disease course≤2 years were divided into early group according to the course of disease.Then to evaluate the clinical features of cardiovascular autonomic nervous function in MSA group,PD group and control group.Meanwhile,the difference of cardiovascular autonomic nervous dysfunction in patients with MSA and PD,different subtypes of MSA(MSA-C and MSA-P),early MSA group and PD group were analysed.The receiver working characteristic curve((ROC))was used to analyze the value of 24h ABPM,HRV and HUTT in the differential diagnosis of early MSA and PD.ResultsThis study included 135 patients with MSA,161 patients with PD and 140 controls.There was no significant statistically difference in gender,age and age of onset among the three groups(P>0.05).Compared with PD group,the course of disease was shorter,the positive rate of head-up tilt test and the incidence of orthostatic hypotension were higher in MDA group(P<0.05).1 MSA,PD and control groupIn the detection of 24-h ABPM,Compared with the control group,the incidences of nocturnal mean systolic blood pressure,nocturnal mean diastolic blood pressure,24-hour mean systolic blood pressure,nocturnal blood pressure load,24-hour systolic blood pressure load,24-hour systolic blood pressure variability,nocturnal hypertension and reverse dipper blood pressure were significantly higher(P<0.05),while the mean decrease rate of nocturnal blood pressure and the incidence of dipper blood pressure were decreased in MSA and PD group(P<0.05).the 24-hour mean diastolic blood pressure,daytime blood pressure load,24-hour diastolic blood pressure variability and the incidence of hypertension were significantly increased in the MSA group(P<0.05).Compared with PD group,the incidences of nocturnal mean systolic blood pressure,nocturnal mean diastolic blood pressure,nocturnal mean blood pressure,24-hour mean systolic blood pressure,24-hour mean systolic blood pressure,nocturnal blood pressure load,24-hour systolic blood pressure load,24-hour systolic blood pressure variability,nocturnal hypertension and reverse dipper blood pressure were significantly higher,and the mean decrease rate of nocturnal blood pressure was lower in MSA(P<0.05).In the detection of HRV,the levels of Low frequency power(LF),High frequency power(HF)and LF/HF in MSA group and PD group were significantly lower than those in control group(P<0.05).Compared with PD group,standard deviation of N-N intervals(SDNN)decreased more significantly in MSA group(P<0.05).In HUTT detection,compared with PD group,the tile systolic blood pressure and diastolic blood pressure decreased more significantly,the diastolic blood pressure in supine position was higher,while the difference in systolic blood pressure and diastolic blood pressure between supine and tilt position was larger in MSA group(P<0.05).2 MSA-C,MSA-Pand PD groupsIn the 24-h ABPM check,the average nocturnal systolic blood pressure,nocturnal diastolic blood pressure,nocturnal mean blood pressure,24-hour mean systolic blood pressure,24-hour mean blood pressure,nocturnal systolic blood pressure load and the incidence of nocturnal hypertension in MSA-C and MSA-P groups were significantly higher than those in PD group(P<0.05),while the decrease rate of nocturnal systolic blood pressure in MSA-C and MSA-P groups was lower(P<0.05).Compared with PD,the nocturnal diastolic blood pressure load,24-hour systolic blood pressure load,24-hour systolic blood pressure variability,24-hour diastolic blood pressure variability and the incidence of reverse dipper blood pressure increased,but the mean decrease rate of nocturnal diastolic blood pressure and nocturnal mean blood pressure decreased in MSA-P group(P<0.05).There was no significant difference in related indexes between MSA-C and MSA-P groups(P>0.05).In HRV detection,compared with PD group,SDNN decreased more significantly in MSA-P group(P<0.05),but there was no significant difference in other indexes among the three groups(P>0.05).In the HUTT test,compared with the PD,the tilt systolic blood pressure decreased more significantly,and the difference in systolic blood pressure and diastolic blood pressure between supine and tilt position was larger in the MSA-C and MSA-P groups(P<0.05).The diastolic blood pressure in the tilt position decreased more significantly in the MSA-P group(P<0.05).There was no significant difference in related indexes between MSA-C and MSA-P groups(P>0.05).3 Early MSA and early PD groupIn the 24-h ABPM index,compared with early PD group,the incidences of nocturnal mean systolic blood pressure,nocturnal mean diastolic blood pressure,nocturnal mean blood pressure,nocturnal average heart rate,nocturnal systolic blood pressure load,24-hour systolic blood pressure variability,nocturnal hypertension and reverse dipper blood pressure were significantly higher(P<0.05),and the mean decreasing rate of nocturnal blood pressure and the incidence of weak spoon blood pressure decreased significantly in the early MSA group(P<0.05).In the detection of HRV,compared with the early PD group,SDNN decreased more significantly in the early MSA group(P<0.05),but there was no significant difference in other heart rate variability indexes(P>0.05).During HUTT,compared with the early PD group,the tilt systolic blood pressure and diastolic blood pressure decreased more significantly,while the diastolic blood pressure in supine position was higher,and the difference in systolic blood pressure and diastolic blood pressure between supine and tilt position was larger than that in early MSA group(P<0.05).4 Correlation Analysis of HUTTPositive head-up tilt test was positively correlated with orthostatic hypotension in early MSA group(P<0.05),while there was no significant correlation between them in PD group(P>0.05).5 ROC curve analysisROC curve shows that nocturnal mean systolic blood pressure>125mmHg,nocturnal mean diastolic blood pressure>73mmHg;24-hour systolic blood pressure variability>0.08;nocturnal systolic blood pressure decrease<0.94%;SDNN≤147.6ms;the combination of 24-hour systolic blood pressure variability,nocturnal systolic blood pressure decrease rate and SDNN>0.57;tile systolic blood pressure≤115mmHg;tile diastolic blood pressure≤76mmHg,difference in systolic blood pressure between supine and tilt position≥17mmHg,difference in diastolic blood pressure between supine and tilt position≥3mmHg have certain value in differential diagnosis of early MSA and PD,and it is more inclined to diagnose MSA.Among them,the diagnostic value of difference in diastolic blood pressure between supine and tilt position and combined index was relatively high(P<0.05).Conclusion1.In the early stage of the disease,the cardiovascular autonomic nervous dysfunction of MSA is more significant than that of PD,and it has a certain value of differential diagnosis from PD.The severity of cardiovascular autonomic nervous dysfunction was similar in MSA-C and MSA-P groups.2.The monitoring indexes of 24-h ABPM,HRV and HUTT have certain value in differential diagnosis of MSA and PD.Among them,when the combined index of 24-hour systolic blood pressure variability,nocturnal systolic blood pressure mean decrease rate and SDNN>0.57 and the difference in diastolic blood pressure between supine and tilt position≥3mmHg,the diagnostic value was relatively higher,and it was more inclined to diagnose MSA.