Koistinen M J, Airaksinen K E, Huikuri H V, Pirttiaho H, Linnaluoto M K, Ikäheimo M J, Takkunen J T
Department of Medicine, Oulu University, Finland.
Acta Diabetol. 1992;28(3-4):199-202. doi: 10.1007/BF00778998.
To elucidate the potential association of diabetic autonomic neuropathy with increased prevalence of silent coronary artery disease (CAD), 138 asymptomatic diabetic subjects were screened using exercise ECG. 24-h ambulatory ECG and dynamic thallium scintigraphy. Fourteen patients with exercise-induced myocardial ischaemia and angiographically confirmed CAD (greater than or equal to 50% coronary artery narrowing) were found using this protocol. Their autonomic nervous function was assessed using standard cardiovascular tests and compared with that of 23 consecutive diabetic patients catheterised because of symptomatic CAD (mean New York Heart Association class 3.0). The diabetic patients with symptomatic CAD had more severe coronary atherosclerosis than the diabetic patients with asymptomatic CAD assessed by jeopardy score (P less than 0.01). The groups did not, however, differ with respect to autonomic function tests. Five patients (22%) with symptomatic CAD and 3 patients (21%) with asymptomatic CAD had definite autonomic dysfunction, i.e. two or more abnormal tests. Thus, our results suggest that the frequency of autonomic neuropathy is not increased in diabetic patients with asymptomatic CAD. The contribution of diabetic autonomic neuropathy to the absence of cardiac pain needs further clinical and pathological studies.
为了阐明糖尿病自主神经病变与无症状性冠状动脉疾病（CAD）患病率增加之间的潜在关联，我们使用运动心电图、24小时动态心电图和动态铊闪烁扫描对138例无症状糖尿病患者进行了筛查。通过该方案，我们发现了14例运动诱发心肌缺血且经血管造影证实患有CAD（冠状动脉狭窄大于或等于50%）的患者。使用标准心血管测试评估了他们的自主神经功能，并与23例因有症状CAD（纽约心脏协会平均分级为3.0级）而接受导管插入术的连续糖尿病患者的自主神经功能进行了比较。通过危险评分评估，有症状CAD的糖尿病患者比无症状CAD的糖尿病患者患有更严重的冠状动脉粥样硬化（P<0.01）。然而，两组在自主神经功能测试方面并无差异。5例（22%）有症状CAD的患者和3例（21%）无症状CAD的患者存在明确的自主神经功能障碍，即两项或更多项测试异常。因此，我们的结果表明，无症状CAD的糖尿病患者中自主神经病变的发生率并未增加。糖尿病自主神经病变对无心脏疼痛的影响需要进一步的临床和病理研究。
