Luft D, Maisch C, Hofmann-Krück V, Radjaipour M, Häring H U
Fourth Department of Internal Medicine, Eberhard-Karls University, Tübingen, Germany.
Clin Auton Res. 2000 Jun;10(3):131-7. doi: 10.1007/BF02278017.
In some patients with type 1 diabetes, various physiologic reactions during a cold pressor test (CPT) are impaired. Whether this is caused by diabetic autonomic neuropathy, disturbed secretion of catecholamines, or disturbed blood glucose control is unknown. The authors, therefore, performed CPTs in patients with type 1 diabetes and in control subjects. They measured blood glucose concentrations, insulin concentrations, cardiac autonomic reflexes, and (before and after the CPT) venous catecholamine concentrations and analyzed correlations between these variables. Twenty-two patients with type 1 diabetes (17 men, 5 women; mean age +/- SD, 26.6 +/- 6.5 y; diabetes duration, 7.6 +/- 0.7 y; glycosylated hemoglobin concentration, 7.7 +/- 2.4%) and 35 control subjects with comparable age and gender distributions were studied. Venous catecholamines were measured before and at the end of a 5-minute CPT. In patients with diabetes, only noradrenaline concentrations increased during the CPT, whereas adrenaline concentrations that were already increased at rest did not change. Adrenaline concentrations correlated inversely with insulin concentrations. In control subjects, both adrenaline and noradrenaline increased significantly during the CPT. In both groups, the magnitude of the individual change in catecholamine concentrations was inversely correlated with the respective resting concentration. Changes in catecholamines, cardiovascular reflex tests, and blood glucose concentrations did not correlate with blood pressure changes. The authors conclude that, in patients with diabetes, resting adrenaline concentrations are related to insulin concentrations. Contrary to control subjects, in patients with diabetes, only noradrenaline increased during CPTs. In both groups, changes in catecholamine concentrations after the CPT were inversely related to the respective resting concentrations.
在一些1型糖尿病患者中，冷加压试验（CPT）期间的各种生理反应受损。这是由糖尿病自主神经病变、儿茶酚胺分泌紊乱还是血糖控制紊乱所致尚不清楚。因此，作者对1型糖尿病患者和对照受试者进行了CPT。他们测量了血糖浓度、胰岛素浓度、心脏自主反射以及（CPT前后）静脉儿茶酚胺浓度，并分析了这些变量之间的相关性。研究了22例1型糖尿病患者（17例男性，5例女性；平均年龄±标准差，26.6±6.5岁；糖尿病病程，7.6±0.7年；糖化血红蛋白浓度，7.7±2.4%）和35例年龄和性别分布相当的对照受试者。在5分钟CPT之前和结束时测量静脉儿茶酚胺。在糖尿病患者中，CPT期间只有去甲肾上腺素浓度增加，而静息时已升高的肾上腺素浓度没有变化。肾上腺素浓度与胰岛素浓度呈负相关。在对照受试者中，CPT期间肾上腺素和去甲肾上腺素均显著增加。在两组中，儿茶酚胺浓度的个体变化幅度与各自的静息浓度呈负相关。儿茶酚胺、心血管反射试验和血糖浓度的变化与血压变化无关。作者得出结论，在糖尿病患者中，静息肾上腺素浓度与胰岛素浓度有关。与对照受试者相反，在糖尿病患者中，CPT期间只有去甲肾上腺素增加。在两组中，CPT后儿茶酚胺浓度的变化与各自的静息浓度呈负相关。
