Nakagawa Mikiko, Takahashi Naohiko, Shinohara Tetsuji, Taniguchi Yayoi, Anan Futoshi, Yonemochi Hidetoshi, Saikawa Tetsuo
Department of Cardiovascular Science, Division of Laboratory Medicine, Oita University School of Medicine, Yufu.
Rinsho Byori. 2006 Aug;54(8):838-43.
There are several examinations to evaluate cardiac autonomic function. Autonomic neuropathy is a common complication of diabetes mellitus and is associated with increased mortality. Baroreflex sensitivity (BRS) is a marker for the ability to augment vagal activity. Several studies have shown that BRS is impaired in diabetes with autonomic neuropathy. The head-up tilt test is the most useful tool to diagnose the neurally mediated syncope. We have developed a new non-invasive method to evaluate the baroreflex using downward tilting (DT-BRS). In our previous study conducted in healthy volunteers and diabetic patients, we demonstrated a strong correlation between systolic blood pressure increase and corresponding RR interval lengthening during downward tilting, which yielded DT-BRS values that correlated well with the BRS value obtained by the phenylephrine method (Phe-BRS). Heart rate responses observed after both squatting and standing (squatting test) are assumed to be a simple and useful tool to assess autonomic activity. We reported that indices of the squatting test showed a significant correlation with BRS assessed by Phe-BRS in diabetes. DT-BRS and the squatting test may provide promising information for the assessment of reflex vagal activity in diabetes.
有多种检查可用于评估心脏自主神经功能。自主神经病变是糖尿病的常见并发症，且与死亡率增加相关。压力反射敏感性（BRS）是增强迷走神经活动能力的一个指标。多项研究表明，在伴有自主神经病变的糖尿病患者中，BRS受损。头直立倾斜试验是诊断神经介导性晕厥最有用的工具。我们开发了一种新的非侵入性方法，即利用向下倾斜来评估压力反射（DT-BRS）。在我们之前对健康志愿者和糖尿病患者进行的研究中，我们证明了在向下倾斜过程中收缩压升高与相应RR间期延长之间存在强相关性，由此得出的DT-BRS值与通过去氧肾上腺素法获得的BRS值（Phe-BRS）相关性良好。下蹲和站立后观察到的心率反应（下蹲试验）被认为是评估自主神经活动的一种简单且有用的工具。我们报道，在糖尿病患者中，下蹲试验指标与通过Phe-BRS评估的BRS显著相关。DT-BRS和下蹲试验可能为评估糖尿病患者的迷走神经反射活动提供有前景的信息。
