Dimitropoulos Gerasimos, Tahrani Abd A, Stevens Martin J
Gerasimos Dimitropoulos, Abd A Tahrani, Martin J Stevens, Department of Diabetes and Endocrinology, Heart of England National Health Service Foundation Trust, B15 2TT Birmingham, United Kingdom.
World J Diabetes. 2014 Feb 15;5(1):17-39. doi: 10.4239/wjd.v5.i1.17.
Cardiac autonomic neuropathy (CAN) is an often overlooked and common complication of diabetes mellitus. CAN is associated with increased cardiovascular morbidity and mortality. The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death. In addition, autoimmune and genetic factors are involved in the development of CAN. CAN might be subclinical for several years until the patient develops resting tachycardia, exercise intolerance, postural hypotension, cardiac dysfunction and diabetic cardiomyopathy. During its sub-clinical phase, heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic. Newer imaging techniques (such as scintigraphy) have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system. One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN; however, the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN, and also proposed screening for CAN in patients with diabetes mellitus. A major challenge, however, is the lack of specific treatment to slow the progression or prevent the development of CAN. Lifestyle changes, improved metabolic control might prevent or slow the progression of CAN. Reversal will require combination of these treatments with new targeted therapeutic approaches. The aim of this article is to review the latest evidence regarding the epidemiology, pathogenesis, manifestations, diagnosis and treatment for CAN.
心脏自主神经病变（CAN）是糖尿病一种常被忽视的常见并发症。CAN与心血管发病率和死亡率增加相关。CAN的发病机制复杂，涉及由高血糖激活的一系列途径，导致神经元缺血和细胞死亡。此外，自身免疫和遗传因素也参与CAN的发生发展。CAN可能在数年内处于亚临床状态，直到患者出现静息性心动过速、运动不耐受、体位性低血压、心脏功能障碍和糖尿病性心肌病。在其亚临床阶段，受副交感神经和交感神经张力平衡影响的心率变异性有助于在疾病出现症状之前检测出CAN。更新的成像技术（如闪烁扫描）已能够在临床前期更早地检测出CAN，并能更好地评估交感神经系统。CAN研究的主要困难之一是缺乏对CAN的普遍接受的定义；然而，多伦多糖尿病神经病变共识小组最近发布了CAN诊断和分期的指南，还提议对糖尿病患者进行CAN筛查。然而，一个主要挑战是缺乏减缓CAN进展或预防其发生的特异性治疗方法。生活方式改变、改善代谢控制可能预防或减缓CAN的进展。要实现逆转则需要将这些治疗方法与新的靶向治疗方法相结合。本文旨在综述关于CAN的流行病学、发病机制、表现、诊断和治疗的最新证据。
