Učestalost patološkoga odgovora na ortostatsku provokaciju u bolesnika oboljelih od klinički izoliranoga sindroma [Prevalence of pathological response to orthostatic provocation in patients with clinically isolated syndrome]

Milivojević, Iva (2019) Učestalost patološkoga odgovora na ortostatsku provokaciju u bolesnika oboljelih od klinički izoliranoga sindroma [Prevalence of pathological response to orthostatic provocation in patients with clinically isolated syndrome]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: Autonomic dysfunction is common in people with multiple sclerosis. The aim of this study was to estimate the frequency of pathological response to PP-HUT in people with CIS as well as the correlation of pathological response with localization of demyelinating lesions at MRI, EDSS level, catecholamine values and HRV analysis. ----- Subjects and Methods: Patients older than 18 years of age with CIS diagnosis were included in the study. PP-HUT was performed, blood was taken for catecholamine determination and HRV analyzed using Kubios HRV Standard 3.0.0. Following HRV parameters were analyzed: LF, HF, HF, LF / HF and SDNN. The study also included a group of healthy subjects who had undergone HUT testing without painful stimulation and were included in HRV analysis. Results: Response to PP-HUT was pathological in 47% of subject. No correlation was found between the incidence of pathological response and localization of demyelinating lesions on the MRI and the degree of disability. There was no difference in HRV between patients with CIS and healthy subjects. Patients with demyelinating brain stem lesions had significantly more frequent sympathetic impairments as expressed by LFtilt. Patients with demyelinating lesions in the brainstem had greater neurological disability as expressed by EDSS compared to patients without lesions in the brainstem. ----- Conclusion: Autonomic nervous system dysfunction is frequent in people with CIS with dominant damage of the sympathetic part.

Abstract in Croatian

Uvod: Oštećenje AŽS-a učestalo je u oboljelih od MS-a. Cilj ovog istraživanja bio je procjeniti učestalost patološkog odgovora na PP-HUT-u kod bolesnika s CIS-om te povezanost pozitivnih rezultata s lokalizacijom demijelinizacijskih lezija na MR-u, stupnjem oštećenja iskazanog EDSS-om, razinama kateholamina i HRV-om. ----- Ispitanici i metode: U istraživanju su sudjelovali bolesnici stariji od 18 godina kojima je postavljena dijagnoza CIS-a. Učinjeno je PP-HUT testiranje, uzeta krv za određivanje kateholamina te analiziran HRV pomoću Kubios HRV Standard 3.0.0. programa. Od HRV parametara analizirani su LF, HF, HF.nu, LF/HF i SDNN. U istraživanju je sudjelovala i skupina zdravih ispitanika kojima je učinjeno HUT testiranje bez bolnog podražaja te analiza HRV-a. ----- Rezultati: Patološki odgovor na PP-HUT-u imalo je 47% ispitanika. Nije nađena povezanost između učestalosti patološkog odgovora i lokalizacije demijelinizacijskih lezija na MR-u mozga niti stupnja oštećenja. Nije nađena razlika HRV-a između bolesnika s CIS-om i zdravih ispitanika. Bolesnici koji su imali demijelinizacijske lezije moždanog debla imali su značajno češće simpatičko oštećenje izraženo nižim LFtilt. Bolesnici s lezijama u moždanom deblu imali su veće neurološko oštećenje izraženo EDSS-om u odnosu na bolesnike bez lezija u deblu. ----- Zaključak: Disfunkcija autonomnog živčanog sustava učestala je kod bolesnika s CIS-om uz dominantno oštećenje funkcije simpatičkog dijela ASŽ-a.

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