Witte D R, Tesfaye S, Chaturvedi N, Eaton S E M, Kempler P, Fuller J H
Department of Epidemiology and Public Health, Royal Free and University College London Medical School, 1-19 Torrington Place, London, WC1E 6BT, UK.
Diabetologia. 2005 Jan;48(1):164-71. doi: 10.1007/s00125-004-1617-y. Epub 2004 Dec 24.
AIMS/HYPOTHESIS: Cardiac autonomic neuropathy (CAN) is associated with increased morbidity and mortality in type 1 diabetes. Apart from glycaemic control, risk factors for CAN have not been extensively studied.
As part of the EURODIAB Prospective Complications Study, CAN--defined as either a loss of heart rate variability or postural hypotension on standing--was assessed at baseline and follow-up (7.3+/-0.6 years from baseline) in patients with type 1 diabetes.
Follow-up measurements were available for 956 participants without CAN at baseline (age at baseline 31.3+/-8.9 years, duration of diabetes 13.5+/-8.3 years). During follow-up, 163 (17%) subjects developed CAN, yielding an incidence of 23.4 per 1,000 person-years. Blood pressure, weight, the presence of cardiovascular disease, albuminuria, distal symmetrical polyneuropathy (DSP) and retinopathy at baseline were associated with the incidence of CAN after adjustment for sex, duration of diabetes and HbA(1)c. In a multivariate regression model, baseline factors associated with an increased risk of developing CAN were age [odds ratio (OR)=1.3 per decade, 95% CI 1.1-1.7], HbA(1)c (OR=1.2 per percentage point, 95% CI 1.1-1.4), systolic blood pressure (OR=1.1 per 10 mmHg, 95% CI 1.0-1.3), feeling faint on standing (OR=2.0, 95% CI 1.2-3.2), DSP (OR=1.9, 95% CI 1.2-3.0) and retinopathy (OR=1.7, 95% CI 1.1-2.6).
CONCLUSION/INTERPRETATION: This study confirms the importance of exposure to hyperglycaemia as a risk factor for CAN. A small set of variables, including HbA(1)c, hypertension, DSP and retinopathy, predict the risk of CAN. Clinical trials are needed to address the impact of intensive antihypertensive treatment on CAN in type 1 diabetes.
目的/假设：心脏自主神经病变（CAN）与1型糖尿病患者发病率和死亡率升高相关。除血糖控制外，CAN的危险因素尚未得到广泛研究。
作为欧洲糖尿病前瞻性并发症研究的一部分，在1型糖尿病患者的基线期和随访期（距基线7.3±0.6年）评估CAN，其定义为心率变异性丧失或站立时体位性低血压。
956名基线期无CAN的参与者（基线期年龄31.3±8.9岁，糖尿病病程13.5±8.3年）有随访测量数据。随访期间，163名（17%）受试者发生CAN，发病率为每1000人年23.4例。在对性别、糖尿病病程和糖化血红蛋白（HbA1c）进行校正后，基线期的血压、体重、心血管疾病的存在、蛋白尿、远端对称性多发性神经病变（DSP）和视网膜病变与CAN的发病率相关。在多变量回归模型中，与发生CAN风险增加相关的基线因素为年龄[比值比（OR）=每十年1.3，95%置信区间1.1 - 1.7]、HbA1c（OR=每百分点1.2，95%置信区间1.1 - 1.4）、收缩压（OR=每10 mmHg 1.1，95%置信区间1.0 - 1.3）、站立时头晕（OR=2.0，95%置信区间1.2 - 3.2）、DSP（OR=1.9，95%置信区间1.2 - 3.0）和视网膜病变（OR=1.7，95%置信区间1.1 - 2.6）。
结论/解读：本研究证实高血糖暴露作为CAN危险因素的重要性。包括HbA1c、高血压、DSP和视网膜病变在内的一小部分变量可预测CAN风险。需要进行临床试验以探讨强化降压治疗对1型糖尿病患者CAN的影响。
