Halperin Anthony, Pajuelo Monica, Tornheim Jeffrey A, Vu Nancy, Carnero Andrés M, Galdos-Cardenas Gerson, Ferrufino Lisbeth, Camacho Marilyn, Justiniano Juan, Colanzi Rony, Bowman Natalie M, Morris Tiffany, MacDougall Hamish, Bern Caryn, Moore Steven T, Gilman Robert H
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Laboratory of Infectious Diseases Research, Universidad Peruana Cayetano Heredia, Lima, Peru; Combined Internal Medicine and Pediatrics Residency Program, Yale School of Medicine, New Haven, Connecticut; University of Utah, Salt Lake City, Utah; Universidad Católica Boliviana "San Pablo," Santa Cruz de la Sierra, Bolivia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japonés, Santa Cruz de la Sierra, Bolivia; Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York; School of Psychology, University of Sydney, Sydney, Australia; Division of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Laboratory of Infectious Diseases Research, Universidad Peruana Cayetano Heredia, Lima, Peru; Combined Internal Medicine and Pediatrics Residency Program, Yale School of Medicine, New Haven, Connecticut; University of Utah, Salt Lake City, Utah; Universidad Católica Boliviana "San Pablo," Santa Cruz de la Sierra, Bolivia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Hospital Universitario Japonés, Santa Cruz de la Sierra, Bolivia; Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York; School of Psychology, University of Sydney, Sydney, Australia; Division of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
Am J Trop Med Hyg. 2016 Jun 1;94(6):1290-8. doi: 10.4269/ajtmh.14-0775. Epub 2016 Apr 4.
Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.
自主神经功能障碍在恰加斯病和糖尿病中很常见。这两种疾病中任何一种并发心脏自主神经功能障碍的患者死亡率都会增加，但目前尚无自主神经功能障碍的临床预测指标。瞳孔对光反射（PLRs）可能有助于早期识别此类患者，从而加强治疗。为了评估PLRs的意义，研究人员从玻利维亚一家教学医院的门诊内分泌科、心脏病科和外科诊所招募了成年人。在检测恰加斯病和糖尿病后，参与者完成了传统自主神经测试（CAT），评估他们对瓦尔萨尔瓦动作、深呼吸和体位变化的心血管反应。使用专门设计的护目镜测量PLRs，然后将CAT和PLRs作为自主神经功能障碍的指标进行比较。本研究分析了163名成年人，包括96名恰加斯病患者、35名糖尿病患者和32名对照组。恰加斯病患者和对照组之间的PLRs没有显著差异。糖尿病患者与非糖尿病患者相比，瞳孔收缩开始的潜伏期更长，最大收缩速度更慢，体位性比率更小。PLRs与CAT结果的相关性较差。基于PLR的临床风险评分显示，与血液检测、CAT和PLRs联合使用相比，糖尿病并发自主神经功能障碍的可能性增加了2.27倍（敏感性87.9%，特异性61.3%）。PLRs是评估无症状自主神经功能障碍的糖尿病患者亚临床神经病变的一个有前景的工具。瞳孔测量法在恰加斯病患者的评估中没有作用。
