Maser Raelene E, Lenhard M James
Department of Medical Technology, University of Delaware, Newark, DE 19716, USA.
Curr Diabetes Rev. 2007 Aug;3(3):204-11. doi: 10.2174/157339907781368931.
The prevalence of obesity is rising to epidemic proportions in many countries worldwide. Obesity seriously increases an individual's risk of developing many health problems including diabetes. Diabetes, like obesity, is also in epidemic proportions with 300 million adults predicted to have the disease by 2025. Investigating strategies for the prevention and treatment of obesity and diabetes is vitally important. Autonomic dysfunction is evident in both obesity and diabetes. In persons with diabetes, impaired cardiovascular autonomic activity is characterized by a reduction in parasympathetic tone with a relative increase in sympathetic activity and is specifically associated with a number of clinically significant manifestations including exercise intolerance, intraoperative cardiovascular lability, orthostatic hypotension, silent myocardial ischemia, and increased risk of mortality. In obesity, parasympathetic function is decreased while regional heterogeneity of increased sympathetic activity may occur. Autonomic dysfunction increases cardiovascular workload, hemodynamic stress, serious dysrhythmias, and significant cardiac pathology. Thus, cardiac autonomic imbalance may also be an important link between obesity and increased morbidity and mortality. Beyond the obese and diabetic state, multiple variables associated with these conditions such as insulin, glucose, leptin, adiponectin and free fatty acids have an affect on the autonomic nervous system. Autonomic disturbances, however, appear to be reversible with weight reduction. Since autonomic imbalance is a marker of adverse risk, improvement obtained from weight loss should be beneficial for the health of individuals with obesity and diabetes. This overview will examine the relationship of the autonomic nervous system in obesity and diabetes and explore the effect of weight loss on autonomic function.
在世界许多国家，肥胖症的患病率正上升至流行程度。肥胖严重增加了个体患包括糖尿病在内的多种健康问题的风险。糖尿病，与肥胖症一样，也呈流行态势，预计到2025年将有3亿成年人患有此病。研究肥胖症和糖尿病的预防及治疗策略至关重要。自主神经功能障碍在肥胖症和糖尿病中均很明显。在糖尿病患者中，心血管自主神经活动受损的特征是副交感神经张力降低，交感神经活动相对增加，并且具体与一些具有临床意义的表现相关，包括运动不耐受、术中心血管不稳定、直立性低血压、无症状心肌缺血以及死亡风险增加。在肥胖症中，副交感神经功能降低，而交感神经活动增加可能存在区域异质性。自主神经功能障碍会增加心血管负荷、血流动力学应激、严重心律失常以及显著的心脏病变。因此，心脏自主神经失衡也可能是肥胖症与发病率和死亡率增加之间的重要联系。除了肥胖和糖尿病状态外，与这些病症相关的多个变量，如胰岛素、葡萄糖、瘦素、脂联素和游离脂肪酸，都会对自主神经系统产生影响。然而，自主神经紊乱似乎可通过减轻体重而逆转。由于自主神经失衡是不良风险的一个标志，体重减轻所带来的改善应对肥胖症和糖尿病患者的健康有益。本综述将研究自主神经系统在肥胖症和糖尿病中的关系，并探讨体重减轻对自主神经功能的影响。
