Donckier J E, De Coster P M, Buysschaert M, Pieters D P, Cauwe F M, Robert A, Brichant C M, Berbinschi A C, Ketelslegers J M
Division of Endocrinology, University of Louvain, Belgium.
Diabetes Care. 1989 Jul-Aug;12(7):475-80. doi: 10.2337/diacare.12.7.475.
To study whether the release of atrial natriuretic factor (ANF) was altered in diabetic cardiac autonomic neuropathy (CAN), we determined plasma ANF concentrations during exercise and changes of posture in three groups of age- and sex-matched subjects (9 healthy subjects, 7 diabetic patients with CAN, and 7 diabetic patients without CAN). During exercise, plasma ANF concentrations rose threefold (P less than .001), and this increase was similar in the three groups. However, heart-rate response to exercise was impaired in the two groups of diabetic patients (P less than .004 vs. healthy subjects) but was more severely impaired in patients with CAN (P less than .03 vs. patients without CAN). In healthy subjects and patients without CAN, the increases of ANF during exercise correlated significantly with those of heart rate, systolic blood pressure, and rate-pressure product (P less than .01). In patients with CAN, the correlation was found exclusively with heart rate (P less than .01). An increase of ventricular ejection fraction occurred in all groups (P less than .001) but without showing statistical differences between groups. After 30 min of standing, a similar postural drop of plasma ANF concentrations (P less than .002) was observed in all subjects, reflecting preserved sympathetic control of vessels. In conclusion, exercise induces an increase of plasma ANF in diabetic patients with CAN. This increase, occurring similarly to healthy subjects, indicates that autonomic activation plays a minor role in ANF release during exercise. Impaired heart-rate response to exercise in patients without CAN suggests early damage of autonomic function, undetected by conventional rest tests.
为研究糖尿病性心脏自主神经病变（CAN）时心房利钠因子（ANF）的释放是否改变，我们测定了三组年龄和性别匹配的受试者（9名健康受试者、7名患有CAN的糖尿病患者和7名未患CAN的糖尿病患者）运动期间及体位改变时的血浆ANF浓度。运动期间，血浆ANF浓度升高了两倍（P<0.001），且三组升高情况相似。然而，两组糖尿病患者运动时的心率反应受损（与健康受试者相比，P<0.004），但患CAN的患者受损更严重（与未患CAN的患者相比，P<0.03）。在健康受试者和未患CAN的患者中，运动期间ANF的升高与心率、收缩压及心率-血压乘积的升高显著相关（P<0.01）。在患CAN的患者中，仅发现与心率相关（P<0.01）。所有组的心室射血分数均升高（P<0.001），但组间无统计学差异。站立30分钟后，所有受试者血浆ANF浓度均出现类似的体位性下降（P<0.002），反映出血管的交感神经控制功能保留。总之，运动可使患CAN的糖尿病患者血浆ANF升高。这种升高与健康受试者相似，表明自主神经激活在运动期间ANF释放中起次要作用。未患CAN的患者运动时心率反应受损提示自主神经功能早期受损，而传统静息试验未检测到。
