Endocrinology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
Neurology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
Diabetes Care. 2014 Sep;37(9):2640-2. doi: 10.2337/dc14-0528. Epub 2014 Jun 26.
We hypothesized the meaningful coexistence of neuropathic pain and nondipping in painful diabetic polyneuropathy (PDPN).
In 113 patients with PDPN, with painless diabetic polyneuropathy (DPN(+)) and without DPN (DPN(-)), neuropathic pain, sleep, risk for obstructive sleep apnea (OSA), autonomic function, and blood pressure (BP) circadian pattern were assessed using the Douleur Neuropathique en 4 Questions (DN4), the Medical Outcomes Study Sleep Scale, the Berlin Questionnaire, cardiovascular reflex tests, and ambulatory BP monitoring.
Patients with PDPN showed higher nighttime systolic BP (130.4 ± 15.6 mmHg) than both DPN(-) (119.9 ± 10.6 mmHg; P < 0.0001) and DPN(+) patients (124.2 ± 12.3 mmHg; P < 0.05), and lower day-night difference (∆) in systolic BP (5.5 ± 6.5 vs. 8.6 ± 7.7%; P < 0.05) and diastolic BP than DPN(-) patients. In a stepwise regression analysis, orthostatic hypotension, high risk for OSA, and PDPN (DN4 interview) were independent determinants of ∆ in systolic BP (r = 0.46; P = 0.0001), ∆ in diastolic BP, and nighttime systolic BP.
PDPN is associated with higher nocturnal systolic BP and impaired BP circadian pattern independent of pain-related comorbidities, suggesting a condition of high cardiovascular risk.
我们假设在痛性糖尿病多发性神经病（PDPN）中，存在神经病理性疼痛和非杓型血压并存的情况。
在 113 例 PDPN 患者中，根据是否存在无痛性糖尿病多发性神经病（DPN(+)）分为 PDPN（有疼痛）和 DPN（无疼痛）两组，评估两组患者的神经病理性疼痛、睡眠、阻塞性睡眠呼吸暂停（OSA）风险、自主神经功能和血压（BP）昼夜节律模式，使用 4 个问题的神经性疼痛问卷（DN4）、医学结局研究睡眠量表、柏林问卷、心血管反射试验和动态血压监测进行评估。
PDPN 患者夜间收缩压（130.4 ± 15.6mmHg）高于 DPN（无疼痛）患者（119.9 ± 10.6mmHg；P < 0.0001）和 DPN（有疼痛）患者（124.2 ± 12.3mmHg；P < 0.05），且日间-夜间收缩压差值（∆）更小（5.5 ± 6.5 vs. 8.6 ± 7.7%；P < 0.05）和舒张压差值更小。在逐步回归分析中，直立性低血压、OSA 高风险和 PDPN（DN4 访谈）是收缩压∆（r = 0.46；P = 0.0001）、舒张压∆和夜间收缩压的独立决定因素。
PDPN 与夜间收缩压升高和血压昼夜节律模式受损相关，与疼痛相关的合并症无关，提示存在心血管风险较高的情况。
