Eastern Virginia Medical School, Strelitz Diabetes Research Center and Neuroendocrine Unit, 855 W Brambleton Avenue, Norfolk, VA 23510, USA.
Diabet Med. 2011 Jun;28(6):643-51. doi: 10.1111/j.1464-5491.2010.03184.x.
It has long been recognized that cardiac autonomic neuropathy increases morbidity and mortality in diabetes and may have greater predictive power than traditional risk factors for cardiovascular events. Significant morbidity and mortality can now be attributable to autonomic imbalance between the sympathetic and parasympathetic nervous system regulation of cardiovascular function. New and emerging syndromes include orthostatic tachycardia, orthostatic bradycardia and an inability to use heart rate as a guide to exercise intensity because of the resting tachycardia. Recent studies have shown that autonomic imbalance may be a predictor of risk of sudden death with intensification of glycaemic control. This review examines an association of autonomic dysregulation and the role of inflammatory cytokines and adipocytokines that promote cardiovascular risk. In addition, conditions of autonomic imbalance associated with cardiovascular risk are discussed. Potential treatment for restoration of autonomic balance is outlined.
长期以来，人们已经认识到心脏自主神经病变会增加糖尿病患者的发病率和死亡率，并且可能比心血管事件的传统危险因素具有更大的预测能力。现在，由于交感神经和副交感神经系统对心血管功能的调节失衡，大量的发病率和死亡率可归因于自主神经失衡。新出现的综合征包括体位性心动过速、体位性心动过缓以及由于静息时心动过速而无法将心率作为运动强度的指导。最近的研究表明，自主神经失衡可能是血糖控制强化后猝死风险的预测指标。本文综述了自主神经调节障碍与促进心血管风险的炎症细胞因子和脂肪细胞因子的关系。此外，还讨论了与心血管风险相关的自主神经失衡的情况。概述了恢复自主平衡的潜在治疗方法。
