Laederach-Hofmann K, Mussgay L, Winter A, Klinkenberg N, Rüddel H
Unit of Psychosomatic and Psychosocial Medicine, University of Berne, Switzerland.
Clin Physiol. 1999 Mar;19(2):97-106. doi: 10.1046/j.1365-2281.1999.00150.x.
Patients with diabetes mellitus (DM) often have alterations of the autonomic nervous system (ANS), even early in their disease course. Previous research has not evaluated whether these changes may have consequences on adaptation mechanisms in DM, e.g. to mental stress. We therefore evaluated whether patients with DM who already had early alterations of the ANS reacted with an abnormal regulatory pattern to mental stress. We used the spectral analysis technique, known to be valuable and reliable in the investigation of disturbances of the ANS. We investigated 34 patients with DM without clinical evidence of ANS dysfunction (e.g. orthostatic hypotension) and 44 normal control subjects (NC group). No patients on medication known to alter ANS responses were accepted. The investigation consisted of a resting state evaluation and a mental stress task (BonnDet). In basal values, only the 21 patients with type 2 DM were different in respect to body mass index and systolic blood pressure. In the study parameters we found significantly lower values in resting and mental stress spectral power of mid-frequency band (known to represent predominantly sympathetic influences) and of high-frequency and respiration bands (known to represent parasympathetic influences) in patients with DM (types 1 and 2) compared with NC group (5.3 +/- 1.2 ms2 vs. 6.1 +/- 1.3 ms2, and 5.5 +/- 1.6 ms2 vs. 6.2 +/- 1.5 ms2, and 4.6 +/- 1.7 ms2 vs. 6.2 +/- 1.5 ms2, for resting values respectively; 4.7 +/- 1.4 ms2 vs. 5.9 +/- 1.2 ms2, and 4.6 +/- 1.9 ms2 vs. 5.6 +/- 1.7 ms2, and 3.7 +/- 2.1 ms2 vs. 5.6 +/- 1.7 ms2, for stress values respectively; M/F ratio 6/26 vs. 30/14). These differences remained significant even when controlled for age, sex, and body weight. However, patients with DM type 2 (and significantly higher body weight) showed only significant values in mental stress modulus values. There were no specific group effects in the patients with DM in adaptation mechanisms to mental stress compared with the NC group. These findings demonstrate that power spectral examinations at rest are sufficiently reliable to diagnose early alterations in ANS in patients with DM. The spectral analysis technique is sensitive and reliable in investigation of ANS in patients with DM without clinically symptomatic autonomic dysfunction.
糖尿病（DM）患者即使在病程早期也常伴有自主神经系统（ANS）的改变。以往的研究尚未评估这些变化是否会对糖尿病的适应机制产生影响，例如对精神压力的适应机制。因此，我们评估了已经出现ANS早期改变的糖尿病患者在面对精神压力时是否会出现异常的调节模式。我们使用了频谱分析技术，该技术在研究ANS紊乱方面具有重要价值且可靠。我们调查了34例无ANS功能障碍临床证据（如直立性低血压）的糖尿病患者和44名正常对照者（NC组）。不纳入已知会改变ANS反应的药物治疗患者。研究包括静息状态评估和精神压力任务（BonnDet）。在基础值方面，仅21例2型糖尿病患者在体重指数和收缩压方面有所不同。在研究参数中，我们发现与NC组相比，1型和2型糖尿病患者在静息和精神压力状态下，中频带（主要代表交感神经影响）、高频带和呼吸带（主要代表副交感神经影响）的频谱功率值显著降低（静息值分别为5.3±1.2ms²对6.1±1.3ms²、5.5±1.6ms²对6.2±1.5ms²、4.6±1.7ms²对6.2±1.5ms²；压力值分别为4.7±1.4ms²对5.9±1.2ms²、4.6±1.9ms²对5.6±1.7ms²、3.7±2.1ms²对5.6±1.7ms²；M/F比值为6/26对30/14）。即使在对年龄、性别和体重进行校正后，这些差异仍然显著。然而，2型糖尿病患者（体重明显更高）仅在精神压力模量值方面有显著差异。与NC组相比，糖尿病患者在对精神压力的适应机制方面没有特定的组间效应。这些发现表明，静息状态下的心功率谱检查对于诊断糖尿病患者ANS的早期改变具有足够的可靠性。频谱分析技术在调查无临床症状性自主神经功能障碍的糖尿病患者的ANS方面敏感且可靠。
