Lefrandt J D, Smit A J, Zeebregts C J, Gans R O B, Hoogenberg K H
Department of Internal Medicine, University Medical Center Groningen and University of Groningen, 9713 GZ Groningen, The Netherlands.
Curr Diabetes Rev. 2010 Nov;6(6):348-58. doi: 10.2174/157339910793499128.
In 1976, D.J. Ewing showed a clear survival disadvantage for diabetic patients that had 'diabetic autonomic neuropathy', as assessed by heart rate and blood pressure variations during a battery of bedside tests. However, these variations do not solely depend on autonomic nervous system function, but also and possibly to a more important extent on the integrity of cardiovascular autonomic reflex loops. Increased intima media thickness at the site of the baroreceptors, reduced vascular distensibility, endothelial dysfunction and impaired cardiac function contribute to the cardiovascular autonomic dysfunction. Interestingly, these abnormalities are closely associated with the presence of (micro-) albuminuria that is regarded as a reflection of endothelial dysfunction or vascular damage in diabetes mellitus. Modern techniques to assess cardiovascular autonomic, vascular and cardiac function have improved the ability to detect early abnormalities. Analysis of heart rate variability, baroreflex sensitivity, muscle sympathetic nervous activity, LNMAinfusions and advanced echocardiography have shown that it is the interplay between autonomic control and cardiac and vascular properties that determines cardiovascular autonomic function. Moreover, these modern techniques have improved power to predict survival in diabetic patients in comparison with the classical Ewing's bedside tests. In conclusion, cardiovascular damage may be more important in cardiovascular autonomic dysfunction than neural function.
1976年，D.J.尤因发现，通过一系列床边测试期间的心率和血压变化评估，患有“糖尿病自主神经病变”的糖尿病患者存在明显的生存劣势。然而，这些变化不仅取决于自主神经系统功能，而且可能在更大程度上取决于心血管自主反射环的完整性。压力感受器部位的内膜中层厚度增加、血管扩张性降低、内皮功能障碍和心脏功能受损导致心血管自主功能障碍。有趣的是，这些异常与（微量）白蛋白尿密切相关，白蛋白尿被视为糖尿病内皮功能障碍或血管损伤的反映。评估心血管自主、血管和心脏功能的现代技术提高了检测早期异常的能力。心率变异性分析、压力反射敏感性分析、肌肉交感神经活动分析、低氮甲基丙氨酸输注分析和先进的超声心动图分析表明，自主控制与心脏和血管特性之间的相互作用决定了心血管自主功能。此外，与经典的尤因床边测试相比，这些现代技术在预测糖尿病患者生存方面的能力有所提高。总之，在心血管自主功能障碍中，心血管损伤可能比神经功能更重要。
