Karavanaki-Karanassiou K
2nd Pediatric Department, Aghia Sophia Children's Hospital, Athens, Greece.
J Pediatr Endocrinol Metab. 2001;14 Suppl 5:1379-86.
Diabetic autonomic neuropathy (DAN) is a complication that is clinically evident in adult patients with diabetes mellitus (DM). Characteristic neuronal alterations occur early in the course of the disease. The diagnosis of subclinical DAN has been achieved using tests on heart rate variation (HRV) and pupillary function. In children, the prevalence of abnormality in three or more conventional HR tests ranges from 0.5-10%, the prevalence of reduced HRV using power spectral analysis is reported to be 15%, while the prevalence of pupillary abnormality ranges from 7.9-19%, in different studies. Pupillary tests have been considered more sensitive and reproducible than HR tests. Pupillary abnormalities have shown a relationship with duration of DM and glycemic control, while this has not been observed in HR variables. From the pupillometry studies it is evident that parasympathetic abnormalities precede the sympathetic ones in children, as in adults, with DM. It seems that the best tests for the routine evaluation of autonomic function in children and adolescents with DM are HR response to deep breathing and standing, power spectral analysis of HRV and pupillary adaptation in darkness. It is important to identify the children and adolescents with impaired indices of autonomic neuropathy in order to take appropriate measures to prevent the progression of DAN.
糖尿病自主神经病变（DAN）是糖尿病（DM）成年患者临床上明显的一种并发症。特征性神经元改变在疾病进程早期就会出现。通过心率变异性（HRV）和瞳孔功能测试已实现亚临床DAN的诊断。在儿童中，三项或更多常规HR测试异常的患病率在0.5%-10%之间，据报道使用功率谱分析HRV降低的患病率为15%，而瞳孔异常的患病率在不同研究中为7.9%-19%。瞳孔测试被认为比HR测试更敏感且可重复。瞳孔异常已显示与DM病程和血糖控制有关，而在HR变量中未观察到这种情况。从瞳孔测量研究中可以明显看出，与成人DM患者一样，儿童中副交感神经异常先于交感神经异常出现。对于患有DM的儿童和青少年，自主神经功能的常规评估似乎最佳测试是深呼吸和站立时的HR反应、HRV的功率谱分析以及黑暗中的瞳孔适应性。识别自主神经病变指标受损的儿童和青少年很重要，以便采取适当措施预防DAN的进展。
