Isak Baris, Oflazoglu Buket, Tanridag Tulin, Yitmen Irem, Us Onder
Marmara University, Department of Neurology, Istanbul, Turkey.
Diabetes Metab Res Rev. 2008 Oct;24(7):563-9. doi: 10.1002/dmrr.859.
We have aimed to investigate the presence of peripheral and autonomic neuropathy in individuals who had been diagnosed with impaired glucose tolerance (IGT) on the basis of an oral glucose tolerance test, by comparing with age-matched healthy subjects with an oral glucose tolerance test (OGTT) in normoglycemic ranges.
Conventional nerve conduction studies, heart rate variation variability, heart rate response to deep breathing, heart rate response to valsalva maneuvre, blood pressure response to standing up quickly, hand grip test and sympathetic skin response tests were used to evaluate the IGT and the control subjects.
No obvious statistical difference indicating peripheral neuropathy and/or cardiac autonomic neuropathy was detected between patient group and controls. Amplitudes of sympathetic skin response of two limbs (right upper and lower extremities) were lower in the IGT patient group when compared to healthy controls (p < 0.05) indicating the presence of sudomotor autonomic neuropathy.
Complaints and neurological examinations of patients with IGT were thought to be consistent with small-fiber neuropathy in the early phase of glucose intolerance. Not detecting any neuropathic findings in conventional electroneurography should be attributed to insufficient time allowed for settling down of large-fiber neuropathy. Obtaining no response in some of the patients in addition to general decrease in the amplitudes of sympathetic skin responses indicates that sudomotor fibers tend to be affected earlier in autonomic neuropathy in the group with IGT when compared with healthy controls. Newly diagnosed IGT patients take receive priority in primary protection since the time for settling down of cardiac autonomic neuropathy was short.
我们旨在通过与口服葡萄糖耐量试验（OGTT）结果处于正常血糖范围的年龄匹配健康受试者进行比较，研究基于口服葡萄糖耐量试验被诊断为糖耐量受损（IGT）的个体中是否存在周围神经病变和自主神经病变。
采用传统神经传导研究、心率变异性、深呼吸时的心率反应、瓦尔萨尔瓦动作时的心率反应、快速站立时的血压反应、握力试验和交感皮肤反应试验来评估IGT患者和对照组。
患者组与对照组之间未检测到表明周围神经病变和/或心脏自主神经病变的明显统计学差异。与健康对照组相比，IGT患者组双侧肢体（右上肢和下肢）的交感皮肤反应幅度较低（p < 0.05），表明存在汗腺运动性自主神经病变。
IGT患者的主诉和神经学检查被认为与糖耐量不耐受早期的小纤维神经病变一致。在传统神经电图检查中未发现任何神经病变结果应归因于大纤维神经病变稳定所需时间不足。除了交感皮肤反应幅度普遍降低外，部分患者无反应表明，与健康对照组相比，IGT组自主神经病变中汗腺运动纤维往往更早受到影响。由于心脏自主神经病变稳定所需时间较短，新诊断的IGT患者应优先接受一级预防。
