Itoh Hiroshi, Uebori Seiji, Asai Mahito, Kashiwaya Tagui, Atoh Keita, Makino Isao
Second Department of Medicine, Asahikawa Medical College, Asahikawa.
Intern Med. 2003 Jul;42(7):560-4. doi: 10.2169/internalmedicine.42.560.
Orthostatic hypotension is caused by autonomic nerve dysfunction, mainly by severe sympathetic nerve dysfunction in diabetic patients. Diabetes affects the peripheral nerves in a length-dependent manner. Quantitative sudomotor axon reflex test (QSART) is one of the sensitive tests for detecting sympathetic nerve function. We examined the relation between orthostatic hypotension and QSART at the foot and hand in type 2 diabetic patients.
Thirty-eight type 2 diabetic patients (age, 48.9 +/- 11.9 years; duration of diabetes, 13.4 +/- 8.6 years) and 13 age-matched non-diabetic controls were evaluated. All subjects aged under 65 years old were recruited. All subjects underwent Schellong tests and quantitative sudomotor axon reflex tests (QSART) at the back of the hand and dorsum of the foot.
The sweating volume at the foot dorsum, but not the back of the hand, during the first 10 minutes of QSART was significantly related to the orthostatic hypotension on the Schellong test. In patients with normal, borderline and abnormal blood pressure response to standing, 6 out of 17 (35.3%), 9 out of 12 (75.0%) and 9 out of 9 (100%) had decreased sweating volume of the foot dorsum, respectively.
Our results suggest that orthostatic hypotension may be detected early by QSART at the dorsum of the foot in type 2 diabetic patients.
体位性低血压由自主神经功能障碍引起，在糖尿病患者中主要是严重的交感神经功能障碍所致。糖尿病以长度依赖的方式影响周围神经。定量汗腺轴突反射试验（QSART）是检测交感神经功能的敏感试验之一。我们研究了2型糖尿病患者体位性低血压与足部和手部QSART之间的关系。
对38例2型糖尿病患者（年龄48.9±11.9岁；糖尿病病程13.4±8.6年）和13例年龄匹配的非糖尿病对照者进行评估。招募所有65岁以下的受试者。所有受试者均接受了倾斜试验和手部背部及足部背侧的定量汗腺轴突反射试验（QSART）。
QSART前10分钟期间，足部背侧而非手部的出汗量与倾斜试验中的体位性低血压显著相关。在站立血压反应正常、临界和异常的患者中，足部背侧出汗量减少的分别有17例中的6例（35.3%）、12例中的9例（75.0%）和9例中的9例（100%）。
我们的结果表明，2型糖尿病患者足部背侧的QSART可能早期检测出体位性低血压。
