摘要目的:应用皮肤交感反应（SSR）和R-R间期变异度（RRIV）检测探讨前庭性偏头痛（VM）患者自主神经病变的特征。方法:前瞻性纳入2019年11月1日至2021年12月31日同济大学附属上海市第四人民医院神经内科就医的发作间期的VM患者和同期健康人群，对其进行SSR、RRIV检测，记录各项参数，包括SSR潜伏期、SSR波幅、平静呼吸时RRIV（R%）、深呼吸时RRIV（D%）、深呼吸与平静呼吸的RRIV差（D%-R%）、深呼吸与平静呼吸的RRIV比值（D%/R%），分析VM患者与对照组各项参数的差异性以及各项参数的相关性。结果:共纳入73例VM患者，男12例，女61例，年龄（46±13）岁；健康对照组36名，男6名，女30名，年龄（46±7）岁。73例VM患者检测SSR异常38例（52%）、RRIV异常17例（23%），SSR与RRIV均异常11例（15%）、SSR或RRIV异常44例（60%）。VM患者下肢SSR潜伏期［（1 719±289）ms］较健康对照组［（1 500±349）ms］长（ P=0.001）、上肢SSR波幅［1.6（0.8，3.0）mV］较健康对照组［2.6（1.8，4.2）mV］低（ P=0.006）。VM患者上肢SSR波幅、R%、D%与年龄呈负相关， r s分别为-0.311（ P=0.007）、-0.237（ P=0.043）、-0.263（ P=0.024）；VM患者SSR下肢较上肢潜伏期［（1 719±289）ms比（1 244±185）ms］长（ P<0.001）、波幅［0.8（0.3，1.7）mV比1.6（0.8，3.0）mV］低（ P<0.001）；上肢SSR潜伏期与下肢SSR潜伏期呈正相关（ r=0.436， P<0.001），上肢波幅与下肢波幅呈正相关（ r s=0.456， P<0.001），D%与R%呈正相关（ r s=0.357， P=0.002）。 结论:VM发作间期的自主神经病变特征为交感神经和副交感神经系统之间的失衡以交感神经功能受损为主。

abstractsObjective:To investigate the characteristics of autonomic neuropathy in patients with vestibular migraine (VM) by sympathetic skin reflex (SSR) and R-R interval variation (RRIV).Methods:Seventy-three patients with interseizure VM and 36 healthy controls in the Department of Neurology affiliated to Shanghai Fourth People′s Hospital of Tongji University from November 1, 2019 to December 31, 2021 were prospectively enrolled. SSR and RRIV were performed and relevant parameters were recorded, including SSR latency, SSR amplitude, RRIV during calm breathing (R%), RRIV during deep breathing (D%), RRIV difference between deep breathing and calm breathing (D%-R%), RRIV ratio between deep breathing and calm breathing (D%/R%), and the difference and correlation of various parameters between VM patients and healthy controls were analyzed.Results:Among the 73 patients with VM, there were 12 males and 61 females, and aged (46±13) years. While among 36 healthy controls, there were 6 males and 30 females, and aged (46±7) years. Among the 73 VM patients, abnormal SSR, abnormal RRIV, abnormal SSR and RRIV, and abnormal SSR or RRIV was detected in 38 cases (52%), 17 cases (23%), 11 cases (15%) and 44 cases (60%), respectively. Compared with healthy controls, the lower extremity SSR latency [(1 719±289) ms] in VM patients was longer than that in control group [(1 500±349) ms] ( P=0.001), but the upper extremity SSR amplitude [1.6 (0.8, 3.0) mV] was lower than that in control group [2.6 (1.8, 4.2) mV] ( P=0.006). SSR amplitude, R% and D% were negatively correlated with age in VM patients ( r s=-0.311, P=0.007; r s=-0.237, P=0.043; r s=-0.263, P=0.024, respectively). SSR of lower extremity in VM patients was longer than that of upper extremity [(1 719±289) ms vs (1 244±185) ms, P<0.001], but the amplitude of lower extremity was lower than that of upper extremity [0.8 (0.3, 1.7) mV vs 1.6 (0.8, 3.0) mV, P<0.001]. SSR latency of upper limb was positively correlated with SSR latency of lower limb ( r=0.436, P<0.001), the amplitude of upper limb was positively correlated with amplitude of lower limb ( r s=0.456, P<0.001), and D% was positively correlated with R% ( r s=0.357, P=0.002). Conclusion:The autonomic neuropathy during VM interphase features with imbalance between sympathetic and parasympathetic nervous system, and the sympathetic nerve function is mainly impaired.