Krause Margit, Rüdiger Heinz, Bald Martin, Näke Andrea, Paditz Ekkehart
Department of Pediatrics, University Hospital, Dresden University of Technology, Dresden, Germany.
Pediatr Diabetes. 2009 Jun;10(4):255-63. doi: 10.1111/j.1399-5448.2008.00447.x. Epub 2009 Jan 14.
Increased daytime blood pressure and reduced nocturnal dipping can already be found in children with type 1 diabetes mellitus. We hypothesized that impaired baroreflex sensitivity can cause this abnormal blood pressure behavior in children and adolescents with type 1 diabetes, reflecting an early stage of diabetic autonomic neuropathy.
In the present study, we monitored beat-to-beat blood pressure and pulse interval non-invasively with portapres in 38 patients with type 1 diabetes (7-18 yr) and 14 non-diabetic subjects (5-17 yr). The Trigonometric Regressive Spectral Analysis was used to assign spontaneous oscillations of blood pressure and pulse interval to defined frequency bands between 0.003 and 1.0 Hz and to calculate baroreflex sensitivity. Correlations with diabetes-specific data like hemoglobin A1c (HbA1c) and with 24-h blood pressure measurements were calculated.
The diabetic subjects displayed significantly less variance of blood pressure and pulse interval in the high frequency (HF) bands and a lower BRS. BRS decreased with higher HbA1c and daily insulin dose. We also saw significant changes in spectral variance of blood pressure and pulse interval with these parameters. Patients with higher sympathetic activity (LF/HF-ratio) during daytime measurements displayed more nocturnal dipping.
Our data evidence impaired baroreflex sensitivity in children and adolescents with type 1 diabetes mellitus. We suggest spectral analysis of spontaneous blood pressure and pulse interval oscillations during night sleep to further pursue the role of baroreflex sensitivity in the etiology of the non-dipping phenomenon in diabetic patients.
1型糖尿病患儿已出现日间血压升高和夜间血压下降减弱的情况。我们推测压力反射敏感性受损可能导致1型糖尿病儿童和青少年出现这种异常血压行为，这反映了糖尿病自主神经病变的早期阶段。
在本研究中，我们使用Portapres对38例1型糖尿病患者（7 - 18岁）和14例非糖尿病受试者（5 - 17岁）进行了逐搏血压和脉搏间期的无创监测。采用三角回归谱分析将血压和脉搏间期的自发振荡分配到0.003至1.0 Hz的特定频段，并计算压力反射敏感性。计算其与糖化血红蛋白（HbA1c）等糖尿病特异性数据以及24小时血压测量值的相关性。
糖尿病受试者在高频（HF）频段的血压和脉搏间期变化显著较小，压力反射敏感性较低。压力反射敏感性随HbA1c和每日胰岛素剂量升高而降低。我们还观察到这些参数与血压和脉搏间期的频谱变化存在显著关联。日间测量时交感神经活动较高（低频/高频比值）的患者夜间血压下降更明显。
我们的数据证明1型糖尿病儿童和青少年存在压力反射敏感性受损的情况。我们建议对夜间睡眠期间的自发血压和脉搏间期振荡进行频谱分析，以进一步探究压力反射敏感性在糖尿病患者非勺型现象病因中的作用。
