La disautonomía en pacientes con FM puede ser caracterizada por la hiperactividad simpática implacable durante todo el día asociado con un trastornado respuesta simpática a diferentes factores de estrés. Los autores
El sistema nervioso autónomo (SNA) parece ser el tema de la semana para la Salud Rising. Este estudio combina el sistema nervioso autónomo con el funcionamiento pulmonar – un problema que no se ha hablado en la fibromialgia que yo sepa.
La gente por lo general no vinculan la fibromialgia o síndrome de fatiga crónica en los problemas pulmonares, pero ellos no surgen – sobre todo en EM / SFC – a veces. Algunas personas experimentan “falta de aire” o dificultad para respirar o dificultad al respirar profundamente. Algunos estudios sugieren que la ventilación – el movimiento de aire dentro y fuera de los pulmones – puede reducirse durante el ejercicio de algún paciente con EM / SFC. Staci Stevens, un fisiólogo del ejercicio, se ha preguntado si las pequeñas y muy activos los músculos implicados en la respiración podrían verse afectados en esta enfermedad.
problemas pulmonares pueden no ser el principal síntoma asociado con la FM, pero los problemas con los pulmones podrían estar diciendo si fueran una manifestación de otro problema asociado con el sistema nervioso autónomo.
Los autores llegaron al corazón de la materia en este trabajo rápidamente. Se informó de que el sistema nervioso simpático (SNS) en la fibromialgia) es hiperactivo en reposo, pero luego se dobla o se bloquea cuando se ponen bajo estrés; es decir, es por cable y cansado al “resto” (algo de descanso!) y luego las cosas tienden a torcerse cuando el sistema se pone bajo tensión. (El mismo patrón está presente en el síndrome de fatiga crónica (ME / CFS))
¿Cómo se conectan los pulmones a la fibromialgia? Utilizaron la diabetes. Diabetes no se menciona mucho en relación con la fibromialgia, pero los autores señaló a un problema similar en ANS diabetes que conduce a problemas con el relleno del vaso sanguíneo en los vasos muy pequeños (microvascular) en sangre a los pulmones. En la diabetes esto lleva a un problema con la difusión de monóxido de carbono de los pulmones.
Esa es la misma cosa que parece estar sucediendo en FM.
El estudio
Tomaron 45 pacientes con FM y 45 controles e hicieron un montón de pruebas del sistema nervioso autónomo y del volumen pulmonar y la transferencia de gases, incluido algo llamado factor de transferencia que mide la capacidad del pulmón para difundir el monóxido de carbono. También les hicieron tomar un cuestionario autónomo de 31 preguntas llamado puntaje de síntomas autónomos compuestos o COMPASS.
Resultados
Los pacientes con FM tienen microcirculación funcional y anomalías morfológicas y el patrón anormal de hiperemia reactiva se debe a un mayor tono simpático que conduce a un aumento de la vasoconstricción. Los autores
Observaron que los pacientes con fibromialgia puntuaciones en el cuestionario autónomo (COMPASS) están altamente correlacionados con los del Cuestionario de Impacto de Fibromialgia (FIQ). Eso sugiere que el problema en el sistema nervioso autónomo podría estar contribuyendo a muchos de los síntomas de FM.
Los pacientes con FM pulmones no se ven tan bien. volumen pulmonar total estaba bien, pero cada medida de funcionamiento pulmonar (factor de transferencia de monóxido de carbono, la capacidad de difusión de monóxido de carbono, el volumen de la membrana capilar alveolar y el volumen sanguíneo capilar pulmonar) se redujeron significativamente en los pacientes con fibromialgia.
Otros análisis encontraron que la reducción de la capacidad de difusión pulmonar fue probablemente debido a una reducción significativa en el volumen pulmonar capilar pulmonar; es decir, el volumen microvascular de los pacientes con FM pulmones había disminuido.
Tanto los vasos más pequeños y más común de sangre encontrados, los capilares son responsables de la entrega de sangre para la mayoría de nuestros tejidos. Son tan pequeños que un glóbulo rojo apenas puede caber a través de ellos. A medida que se están entregando las células rojas de la sangre que también están permitiendo que pequeñas moléculas tales como oxígeno, CO2, azúcares y aminoácidos para difundir dentro y fuera de ellos. Esa parte de difusión al parecer no está funcionando muy bien.
Los autores sugirieron que los daños en los nervios autónomos cardíacos estaba causando problemas con “la regulación del tono microvascular” y la distribución de llenado pulmonar. Propusieron que los receptores en las células que causan FM vasos sanguíneos se dilaten los pacientes han sido tan estimulado con el tiempo que no están respondiendo a las señales para dilatar más. Eso deja a los vasos sanguíneos obstruidos, perjudica el flujo de sangre e incluso (creo) podría reducir el volumen de sangre.
Los autores de enumeró una serie de hallazgos que sugieren que los problemas de circulación sería ninguna sorpresa en FM. producción de óxido nítrico reducido impide que los vasos sanguíneos de la apertura suficiente como para mover los vasos sanguíneos en los pacientes de FM de la apertura suficiente como para mover la sangre adecuadamente y causando rigidez de la pared arterial.
También observaron las altas tasas de fenómeno de Raynaud se encuentran en los participantes en este estudio de FM (1 / 3º). Raynaud ocurre cuando espasmos en las arterias restringir los flujos de sangre por lo general a las manos o los pies causando los dedos de manos y pies por lo general se pongan blancas, luego azul y luego como los retornos de sangre, les lleva a sentir un hormigueo o se queman. Esto es a menudo causada por la exposición a temperaturas reducidas. En algunas personas están expuestas a temperaturas inferiores a 60 grados puede causar Reynaud.
El hecho de que los pacientes con FM con los fenómenos de Raynaud tendían a tener peores resultados en las pruebas de pulmón tenía sentido dada la hiperactividad similar del sistema nervioso simpático que se encuentra en Raynaud. Eso, la hiperactividad local, que afecta las arterias y no los vasos sanguíneos más pequeños que se encuentran en los pulmones, es tan extrema que hace que los vasos sanguíneos se vuelvan vasoconstrictos o se estrechen lo suficiente como para que la sangre no pueda pasar.
Raynaud entonces parece ser otra manifestación de un sistema nervioso autónomo desregulado en FM.
Los autores no dedicaron ningún tiempo a la importancia clínica de sus hallazgos y el artículo no deja claro qué son. La difusión reducida del dióxido de carbono se encuentra en muchas enfermedades pulmonares (fibrosis, alveolitis, vasculitis, EPOC, enfisema, hipertensión pulmonar) y anemia (volumen bajo de sangre). No está claro si contribuirían a la dificultad para respirar o problemas respiratorios que a veces se encuentran en ME / CFS o FM o si reflejan un problema que está presente pero que no está causando muchos síntomas.
Esta no es la primera vez que los posibles problemas de la microcirculación han aparecido en FM, sin embargo. Los autores de un estudio de ejercicio 2014 propusieron que los problemas de la microcirculación podrían estar contribuyendo a los resultados bajos VO2 Max que encontraron en los pacientes con FM. Ellos argumentaron que el próximo estudio ejercicio de FM debe examinar los flujos sanguíneos en los pequeños vasos sanguíneos que alimentan los músculos.
- Ver Préstamos de una mano: un enfoque muy diferente a la fibromialgia para obtener información sobre una máquina que pretende aumentar la microcirculación en FM
El daño del nervio Propuestos
Estos autores proponen que los daños en los nervios cardíacos autonómicas era sobre todo probable para explicar el funcionamiento de los pulmones embotado. Esto, por supuesto, no es la primera vez que los daños en los nervios autónomos se ha propuesto o que se encuentran en la FM. Los nervios autónomos se encuentran entre las pequeñas fibras nerviosas que muchos estudios han encontrado ahora dañados en la piel de los pacientes con FM.
El año pasado que el daño se extendió a las fibras nerviosas en el ojo. Recientemente Sommers encontró un patrón inusual de daño nervioso en FM que ahora se llama “patología de fibra pequeña”, para distinguirla de la más típica neuropatía de fibras pequeñas se encuentran en otros trastornos. Caro y Winters han encontrado daños a grandes fibras nerviosas en FM también.
Hace aproximadamente un año, un investigador sugirió que los investigadores ven en profundos nervios más que es probable que encuentren. Su predicción parece hacerse realidad. Desde la piel hasta los ojos a los pulmones, posiblemente, problemas de nervios están surgiendo en la fibromialgia.
¿Cuál podría ser la causa de estos problemas de los nervios? Si los hallazgos de la piel de un grupo español sostienen a continuación, una cerveza de la inflamación, los problemas y el estrés oxidativo mitocondrial podrían llenar el proyecto de ley.
Cortesía: https://www.healthrising.org
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