Meyer M F, Rose C J, Hülsmann J-O, Schatz H, Pfohl M
Department of Internal Medicine, University Clinic Bergmannsheil, Ruhr-University Bochum, D-44789, Bochum, Germany.
Microvasc Res. 2003 Mar;65(2):88-95. doi: 10.1016/s0026-2862(02)00015-8.
Impairment of 0.1-Hz vasomotion, which was found in diabetic patients, was suggested to be an early index of sympathetic dysfunction. We studied the relationships between alterations in vasomotion and both cardiac autonomic and sensory neuropathy. Twenty type 1 and 22 type 2 diabetic patients were investigated. Vasomotion was recorded in single capillaries at the dorsal middle phalangeal area of the left ring finger by means of laser Doppler anemometry. Cardiac autonomic neuropathy was assessed by spectral analysis of heart rate variation during rest and recording heart rate responses to deep breathing and Valsalva manoeuvre. Sensory neuropathy was investigated by measuring heat pain, vibration, and thermal sensory thresholds. Impaired vasomotion was more often (82.4%) found in diabetic patients with at least one altered cardiac autonomic test, but also in 47.1% of those with all of these tests being normal (P = 0.035). Both heart rate variation coefficient during rest (r = 0.40, P = 0.045) and Valsalva ratio (r = 0.41, P = 0.037) correlated positively with amplitudes of vasomotion in type 1 diabetic patients. The prevalence of impaired vasomotion was not higher in patients with sensory neuropathy compared to those with normal sensory functions. A disturbed warm sensation was only found in 2 patients and none had an abnormal heat pain threshold. Our data indicate that impairment of 0.1-Hz vasomotion precedes parasympathetic neuropathy, assessed by heart rate variation tests, and abnormalities in warm and heat pain sensation. Reduction of arteriolar vasomotion, detected by laser Doppler anemometry, might be an early index of sympathetic dysfunction, because it correlates with disturbances in those cardiac autonomic tests, which are at least in part under sympathetic control.
在糖尿病患者中发现的0.1赫兹血管运动受损，被认为是交感神经功能障碍的早期指标。我们研究了血管运动改变与心脏自主神经病变和感觉神经病变之间的关系。对20例1型糖尿病患者和22例2型糖尿病患者进行了调查。通过激光多普勒血流仪记录左手无名指背侧中节指骨区域单根毛细血管的血管运动。通过对静息时心率变异性进行频谱分析以及记录对深呼吸和瓦尔萨尔瓦动作的心率反应来评估心脏自主神经病变。通过测量热痛、振动和热感觉阈值来研究感觉神经病变。血管运动受损在至少一项心脏自主神经测试异常的糖尿病患者中更为常见（82.4%），但在所有这些测试均正常的患者中也有47.1%出现（P = 0.035）。在1型糖尿病患者中，静息时心率变异系数（r = 0.40，P = 0.045）和瓦尔萨尔瓦比值（r = 0.41，P = 0.037）均与血管运动幅度呈正相关。与感觉功能正常的患者相比，感觉神经病变患者中血管运动受损的患病率并不更高。仅在2例患者中发现有温热感觉障碍，且无人有异常热痛阈值。我们的数据表明，通过心率变异性测试评估，0.1赫兹血管运动受损先于副交感神经病变以及温热和热痛感觉异常。通过激光多普勒血流仪检测到的小动脉血管运动减少可能是交感神经功能障碍的早期指标，因为它与那些至少部分受交感神经控制的心脏自主神经测试中的紊乱相关。
