1型糖尿病患者鼻功能及血清一氧化氮水平的改变

Di Nardo Walter, Pitocco Dario, Di Leo Mauro A S, Picciotti Pasqualina M, Di Stasio Enrico, Collina Chiara, Santini Stefano, Scarano Emanuele, Ghirlanda Giovanni

Department of Otolaryngology, Catholic University of the Sacred Heart Rome, Rome, Italy.

J Otolaryngol Head Neck Surg. 2008 Oct;37(5):611-5.

OBJECTIVE

In this study, we evaluated the modifications of nasal function in type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]) by active anterior rhinomanometry (AAR) to understand if involvement of the nasal nervous system and microcirculation could be detected in nasal mucosa.

METHOD

We studied 35 nonsmoking IDDM patients without diabetic complications, nasal pathology, or septal deviation. We measured serum levels of nitric oxide (NO) and nasal airway in three conditions: basal, supine, and after decongestion (phenylephrine hydrochloride 0.25 mg spray) by means of rhinomanometry, determining inspiratory total resistance and nasal airflow. The rhinomanometric results of the IDDM patients were compared with those of control normal subjects. In the IDDM patients, neuropathy was evaluated according to standardized procedures, including the vibration perception threshold test, cardiovascular autonomic tests, conduction velocity test, and fundoscopic examination.

RESULTS

The NO serum level was significantly higher in IDDM patients (12.5 +/- 3.8) compared with normal controls (4.8 +/- 1.4). The AAR results showed that in IDDM patients, inspiratory total resistance in the basal (0.82 +/- 0.4 Pa/cm3) and supine (0.94 +/- 0.7 Pa/cm3) positions and after decongestion (0.59 +/- 0.2 Pa/cm3) were increased compared with the control group in three conditions (basal, 0.52 +/- 0.2 Pa/cm3; supine, 0.58 +/- 0.3 Pa/cm3; after decongestion, 0.48 +/- 0.2 Pa/cm3). After decongestion, there was a greater decrease in nasal resistance in diabetic patients than in normal subjects.

CONCLUSION

Nasal function is involved in IDDM, rhinomanometry can also be considered an important test in the evaluation of this involvement in patients without other signs of diabetic neuropathy, and an increase in NO could partially explain these alterations.

目的

在本研究中，我们通过主动前鼻测压法（AAR）评估1型糖尿病（胰岛素依赖型糖尿病[IDDM]）患者的鼻腔功能改变，以了解鼻黏膜中是否能检测到鼻神经系统和微循环的受累情况。

方法

我们研究了35名无糖尿病并发症、鼻腔病变或鼻中隔偏曲的非吸烟IDDM患者。我们在三种情况下测量血清一氧化氮（NO）水平和鼻气道情况：基础状态、仰卧位以及使用0.25毫克盐酸去氧肾上腺素喷雾进行减充血后，通过鼻测压法测定吸气总阻力和鼻气流。将IDDM患者的鼻测压结果与正常对照受试者的结果进行比较。在IDDM患者中，根据标准化程序评估神经病变，包括振动觉阈值测试、心血管自主神经测试、传导速度测试和眼底检查。

结果

与正常对照组（4.8±1.4）相比，IDDM患者的血清NO水平显著更高（12.5±3.8）。AAR结果显示，在三种情况下，IDDM患者在基础状态（0.82±0.4 Pa/cm³）、仰卧位（0.94±0.7 Pa/cm³）以及减充血后（0.59±0.2 Pa/cm³）的吸气总阻力均高于对照组（基础状态，0.52±0.2 Pa/cm³；仰卧位，0.58±0.3 Pa/cm³；减充血后，0.48±0.2 Pa/cm³）。减充血后，糖尿病患者的鼻阻力下降幅度大于正常受试者。