Lehtinen J M, Uusitupa M, Siitonen O, Pyörälä K
Department of Clinical Neurophysiology, University of Kuopio, Finland.
Diabetes. 1989 Oct;38(10):1307-13. doi: 10.2337/diab.38.10.1307.
We evaluated the prevalence of peripheral neuropathy by clinical and electrophysiological criteria and the prevalence of autonomic parasympathetic nerve dysfunction by heart-rate variation during deep breathing (expiration-to-inspiration ratio [E:1]) in 132 newly diagnosed non-insulin-dependent diabetic (NIDDM) subjects aged 45-64 yr and 142 randomly selected nondiabetic control subjects. The relationship of nerve dysfunction to the degree of hyperglycemia and insulin-secretion capacity were also investigated. Single and scattered symptoms and signs of peripheral neuropathy were found in both diabetic and control subjects. Symptomatic polyneuropathy was found in 1.5% of diabetic subjects but none of the control subjects. Polyneuropathy defined by clinical signs was found in 2.3% of the diabetic subjects and 1.4% of the control subjects. No subjects with both symptoms and signs were seen. Nerve conduction velocities (NCVs) were significantly slower in diabetic than control subjects. Polyneuropathy according to electrophysiological criteria was found in 15.2% of diabetic subjects but was not found in any control subjects. Electromyographic abnormalities were more common in diabetic than control women, but not significant differences were found in men. The resting heart rate was higher in diabetic than control women, but no significant difference was found in men. The mean E:I was significantly lower in diabetic men and women than control men and women. An abnormally low E:I was found in 9.2% of the diabetic men, 3.3% of the control men, 3.3% of the diabetic women, and none of the control women. NCV parameters, but not E:I, were inversely correlated with fasting blood glucose and glycosylated hemoglobin levels. A positive correlation between NCV and fasting and postglucose serum insulin levels was found in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
我们根据临床和电生理标准评估了132名年龄在45 - 64岁新诊断的非胰岛素依赖型糖尿病（NIDDM）患者及142名随机选取的非糖尿病对照者的周围神经病变患病率，并通过深呼吸时心率变异性（呼气与吸气比[E:I]）评估了自主副交感神经功能障碍的患病率。还研究了神经功能障碍与高血糖程度及胰岛素分泌能力之间的关系。糖尿病患者和对照者均出现了周围神经病变的单一及散在症状和体征。1.5%的糖尿病患者出现了有症状的多发性神经病，而对照者中无人出现。根据临床体征定义的多发性神经病在2.3%的糖尿病患者和1.4%的对照者中被发现。未发现同时有症状和体征的患者。糖尿病患者的神经传导速度（NCV）显著慢于对照者。根据电生理标准，15.2%的糖尿病患者存在多发性神经病，而对照者中未发现。糖尿病女性的肌电图异常比对照女性更常见，但男性中未发现显著差异。糖尿病女性的静息心率高于对照女性，但男性中未发现显著差异。糖尿病男性和女性的平均E:I显著低于对照男性和女性。9.2%的糖尿病男性、3.3%的对照男性、3.3%的糖尿病女性出现了异常低的E:I，对照女性中无人出现。NCV参数而非E:I与空腹血糖和糖化血红蛋白水平呈负相关。两组中均发现NCV与空腹及葡萄糖后血清胰岛素水平呈正相关。（摘要截断于250字）
