2型糖尿病患者急性和持续性直立位期间血压稳态受损的预测因素。

Predictors of impaired blood pressure homeostasis during acute and sustained orthostasis in patients with type 2 diabetes.

作者信息

Jarmuzewska E A, Rocchi R, Mangoni A A

机构信息

Department of Internal Medicine, IRCCS Polyclinic, Ospedale Maggiore, University of Milan, Italy.

出版信息

Panminerva Med. 2006 Mar;48(1):67-72.

PMID:16633334

Abstract

AIM

Sympathetic failure with acute postural hypotension is a common feature of advanced autonomic neuropathy in type 2 diabetes. It is unknown, however, whether: a) the presence of sympathetic autonomic neuropathy is also a powerful predictor of postural blood pressure changes during sustained orthostasis and b) other factors affecting baroreceptor and neuro-hormonal control might play a role.

METHODS

Systolic blood pressure (SBP) was measured during supine rest and after 2, 5, and 20 min of active orthostasis in 45 males with type 2 diabetes (age 56.4+/-8.2 years, mean+/-SD) and different degrees of autonomic neuropathy (absence of neuropathy, n=26, parasympathetic neuropathy, n=9, and sympathetic neuropathy, n=10). Eight healthy subjects (50.1+/-11.6 years) served as controls. A multiple backward regression analysis was performed to identify independent predictors of SBP changes during orthostasis. The regression model included presence/absence of sympathetic autonomic neuropathy, age, diabetes duration, presence/absence of hypertension, baseline SBP and neuro-hormonal parameters (plasma adrenaline, noradrenaline, plasma renin activity, and aldosterone).

RESULTS

Sympathetic autonomic neuropathy (P=0.005), baseline SBP (P=0.001), and adrenaline (P=0.003) independently predicted SBP changes after 2 min (R2=0.64); sympathetic autonomic neuropathy (P<0.001), baseline adrenaline (P=0.008), and plasma renin activity (P=0.006) predicted SBP changes after 5 min (R2=0.58); whereas sympathetic autonomic neuropathy (P<0.001) and baseline SBP (P<0.001) predicted SBP changes after 20 min orthostasis (R2=0.65).

CONCLUSIONS

The presence of sympathetic autonomic neuropathy and higher supine SBP values remain strong and independent predictors of SBP fall not only during the acute transition from supine to standing position but also during sustained orthostasis in type 2 diabetes. Lower baseline plasma adrenaline concentrations and plasma renin activity are also involved, though to a lesser extent, in the genesis of this haemodynamic response.

摘要

目的

交感神经功能衰竭伴急性体位性低血压是2型糖尿病晚期自主神经病变的常见特征。然而，尚不清楚：a）交感神经自主神经病变的存在是否也是持续直立位时体位血压变化的有力预测指标；b）影响压力感受器和神经激素控制的其他因素是否可能起作用。

方法

对45名2型糖尿病男性患者（年龄56.4±8.2岁，均值±标准差）进行了仰卧位休息时以及主动直立2分钟、5分钟和20分钟后的收缩压（SBP）测量，这些患者存在不同程度的自主神经病变（无神经病变，n = 26；副交感神经病变，n = 9；交感神经病变，n = 10）。8名健康受试者（50.1±11.6岁）作为对照。进行多元向后回归分析以确定直立位期间SBP变化的独立预测因素。回归模型包括交感神经自主神经病变的有无、年龄、糖尿病病程、高血压的有无、基线SBP以及神经激素参数（血浆肾上腺素、去甲肾上腺素、血浆肾素活性和醛固酮）。

结果

交感神经自主神经病变（P = 0.005）、基线SBP（P = 0.001）和肾上腺素（P = 0.003）独立预测2分钟后的SBP变化（R2 = 0.64）；交感神经自主神经病变（P < 0.001）、基线肾上腺素（P = 0.008）和血浆肾素活性（P = 0.006）预测5分钟后的SBP变化（R2 = 0.58）；而交感神经自主神经病变（P < 0.001）和基线SBP（P < 0.001）预测直立20分钟后的SBP变化（R2 = 0.65）。