Hepburn D A, Deary I J, Frier B M
Department of Diabetes, Royal Infirmary, Edinburgh, Scotland.
Diabet Med. 1992 Jan-Feb;9(1):70-5. doi: 10.1111/j.1464-5491.1992.tb01718.x.
The allocation of some symptoms of acute hypoglycaemia to autonomic and neuroglycopenic groups has proved problematical, with possible misinterpretation of studies which depend upon the use of diverse symptom questionnaires. Two hundred and ninety-five randomly selected insulin-treated diabetic patients were asked to report the symptoms which they usually experienced and believed to be caused by hypoglycaemia. Sweating, trembling, inability to concentrate, weakness, hunger and blurred vision were the most frequently reported symptoms. To classify symptoms of hypoglycaemia objectively, Factor Analysis was used to identify related symptoms which grouped together. This resulted in five groups or clusters of symptoms, four of which could be denominated as groups with a presumed common aetiology, and were labelled: 'neuroglycopenic', 'general malaise', 'autonomic', 'motor dysfunction', and 'sensory dysfunction'. The groups of symptoms derived by Factor Analysis were assessed in relation to partial or absent symptomatic awareness of hypoglycaemia based on historical evidence from the 295 insulin-treated diabetic patients. Neuroglycopenic symptoms were reported more commonly by the patients who had reported partial awareness of hypoglycaemia (number of symptoms 2.6 +/- 1.8 (mean +/- SD] than by the patients who had reported normal hypoglycaemia awareness (1.4 +/- 1.5 symptoms) (p less than 0.05). By contrast autonomic symptoms were reported less frequently by the patients who had reported absent hypoglycaemia awareness (1.3 +/- 1.4 symptoms) than by those with normal awareness (2.2 +/- 1.4 symptoms) (p less than 0.05), which was similar to the number of autonomic symptoms reported by the patients who had partial hypoglycaemia awareness (2.1 +/- 1.3 symptoms).
事实证明，将急性低血糖的某些症状归为自主神经症状组和神经低血糖症状组存在问题，这可能会误解那些依赖使用各种症状问卷的研究。295名随机挑选的接受胰岛素治疗的糖尿病患者被要求报告他们通常经历且认为是由低血糖引起的症状。出汗、颤抖、注意力不集中、虚弱、饥饿和视力模糊是报告频率最高的症状。为了客观地对低血糖症状进行分类，采用因子分析来识别聚集在一起的相关症状。这产生了五组症状群，其中四组可被视为具有假定共同病因的组，并被标记为：“神经低血糖症状组”、“全身不适组”、“自主神经症状组”、“运动功能障碍组”和“感觉功能障碍组”。根据295名接受胰岛素治疗的糖尿病患者的历史证据，对因子分析得出的症状组与低血糖部分症状意识或无症状意识进行了评估。报告有低血糖部分意识的患者（症状数量为2.6±1.8（平均值±标准差））比报告有正常低血糖意识的患者（1.4±1.5个症状）更常报告神经低血糖症状（p<0.05）。相比之下，报告无低血糖意识的患者（1.3±1.4个症状）比有正常意识的患者（2.2±1.4个症状）更少报告自主神经症状（p<0.05），这与报告有低血糖部分意识的患者报告的自主神经症状数量（2.1±1.3个症状）相似。
