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Kardiovaskuläre und pupilläre autonome und somatosensible Neuropathie bei chronischen Erkrankungen mit Autoimmunphänomenen

Cardiovascular and pupillary autonomic neuropathy and sensorimotor neuropathy in chronic diseases with autoimmune phenomenons. A comparative study in patients with Crohn’s disease, ulcerative colitis, systemic lupus erythematosus, systemic sclerosis and insulin-dependent diabetes mellitus

Eine vergleichende Untersuchung bei Patienten mit Morbus Crohn, Colitis ulcerosa, systemischem Lupus erythematodes, progressiver systemsklerose und Typ-I-Diabetes mellitus

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Zusammenfassung

□ Hintergrund

In den vergangenen Jahren ist die Untersuchung des autonomen Nervensystems insbesondere im Bereich der Diabetologie, aber auch in anderen Bereichen der inneren Medizin mehr und mehr in den Blickpunkt des Interesses getreten. Eine vergleichende Untersuchung der autonomen Nervenfunktion bei Patienten mit verschiedenen chronischen Erkrankungen, die mit Autoimmunphänomenen einhergehen, mit standardisierten Untersuchungsverfahren wurde bisher noch nicht vorgestellt. Aufgabe dieser Studie war daher, die vergleichende Erfassung der Häufigkeit und des Ausprägungsgrades der autonomen und somatosensiblen Neuropathie bei Patienten mit Morbus Crohn, Colitis ulcerosa, systemischem Lupus erythematodes, progressiver Systemsklerose und Typ-I-Diabetes mellitus.

□ Patienten und Methoden

Es wurden 28 Patienten mit Morbus Crohn (Alter: 32,4±2,0 Jahre), 17 mit Colitis ulcerosa (39,7±3,6 Jahre), 39 mit systemischem Lupus erythematodes (34,9±2,0 Jahre), 38 mit progressiver Systemsklerose (51,5±2,4 Jahre) und 65 mit Typ-I-Diabetes mellitus (35,5±1,6 Jahre) untersucht. Die kardiovaskuläre autonome (cANP), die pupilläre autonome (pANP) und die somatosensible Neuropathie (ssNP) wurden mittels standardisierter Testverfahren beurteilt.

□ Ergebnisse

Folgende Häufigkeiten wurden für die cANP, pANP und ssNP gefunden: Morbus Crohn (0%, 19%, 7%), Colitis ulcerosa (6%, 25%, 18%), systemischer Lupus erythematodes (5%, 29%, 10%), progressive Systemsklerose (11%, 16%, 32%) und Typ-I-Diabetes mellitus (26%, 66%, 29%).

□ Schlußfolgerung

Diese Untersuchungen zeigen, daß Typ-I-Diabetiker von einer Neuropathie am häufigsten und am schwersten betroffen waren. Aber auch bei Patienten mit anderen chronischen Erkrankungen, insbesondere systemischerm Lupus erythematodes, progressiver Systemsklerose und Colitis ulcerosa, ist eine Neuropathie des autonomen Nervensystems sehr viel häufiger, als bisher vermutet wurde. Patienten mit chronisch-entzündlichen Darmerkrankungen haben selten eine cANP. Patienten mit progressiver Systemsklerose haben häufig eine somatosensible Neuropathie. Die verschiedenen Krankheitsgruppen unterscheiden sich im Muster und im Ausprägungsgrad der autonomen und somatosensiblen Neuropathie, was auf unterschiedliche neuropathogenetische Mechanismen hinweist.

Summary

□ Background

During the last years, examination of autonomic nervous function and of autonomic neuropathy has attracted attention not only in diabetes mellitus research but also in other areas of internal medicine. However, patients with various chronic diseases with autoimmune phenomenons have never been investigated in a comparative study with standardized examination techniques. Hence, the aim of the study was to examine the prevalence and the severity of autonomic neuropathy in patients with the following chronic diseases.

□ Patients and Methods

We investigated 28 patients with Crohn’s disease (CD; age: 32.4±2.0 y), 17 patients with ulcerative colitis (UC; 39.7±3.6 y), 39 patients with systemic lupus erythematosus (SLE; 34.9±2.0 y), 38 patients with progressive systemic sclerosis (pSS; 51.5±2.4 y) and 65 patients with insulin-dependent diabetes mellitus (IDDM; 35.5±1.6 y). Cardiovascular autonomic (cANP), pupillary autonomic (pANP), and sensorimotor (ssNP) neuropathy were assessed by standardized techniques.

□ Results

Prevalence rates for cANP, pANP and ssNP were found to be 0%, 19%, and 7% in CD, 6%, 25%, and 18% in UC, 5%, 29%, and 10% in SLE, 11%, 16%, and 32% in pSS, and 26%, 66%, and 29% in IDDM, respectively.

□ Conclusion

The study demonstrated patients with IDDM to have the highest prevalence rates of cANP and pANP. Patients with other chronic diseases, particularly SLE, pSS and UC, had high prevalence rates of pANP. This may be due to alterations of structures of the central nervous system in these patients. cANP was rare in patients with inflammatory bowel disease and ssNP was found very often in patients with pSS, probably due to local fibrotic lesions. The various disease groups differ in the pattern and severity of autonomic and sensorimotor neuropathy, which indicates that different structures and neuropathogenic mechanisms may be involved.

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  1. Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität, Franz-Josef-Strauß-Allee 11, D-93042, Regensburg

    Rainer H. Straub, Tilo Andus, Guntram Lock, Martin Zeuner, Klaus-Dieter Palitzsch, Volker Gross, Bernhard Lang & Jürgen Schölmerich

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Straub, R.H., Andus, T., Lock, G. et al. Kardiovaskuläre und pupilläre autonome und somatosensible Neuropathie bei chronischen Erkrankungen mit Autoimmunphänomenen. Med. Klin. 92, 647–653 (1997). https://doi.org/10.1007/BF03044820

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