Dimova Rumyana, Tankova Tsvetalina, Guergueltcheva Velina, Tournev Ivailo, Chakarova Nevena, Grozeva Greta, Dakovska Lilia
Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria.
Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria.
J Diabetes Complications. 2017 Mar;31(3):537-543. doi: 10.1016/j.jdiacomp.2016.11.002. Epub 2016 Nov 6.
The present study evaluates autonomic and somatic nerve function in different stages of glucose tolerance and its correlation with different cardio-metabolic parameters.
Four hundred seventy-eight subjects, mean age 49.3±13.7years and mean BMI 31.0±6.2kg/m2, divided according to glucose tolerance: 130 with normal glucose tolerance (NGT), 227 with prediabetes (125 with impaired fasting glucose (IFG) and 102 with isolated impaired glucose tolerance (iIGT)), and 121 with newly-diagnosed T2D (NDT2D), were enrolled. Glucose tolerance was studied during OGTT. Antropometric indices, blood pressure, HbA1c, serum lipids, hsCRP and albumin-to-creatinine ratio were assessed. Body composition was estimated by a bioimpedance method (InBody 720, BioSpace). Tissue AGEs accumulation was assessed by skin autofluorescence (AGE-Reader-DiagnOpticsTM). Electroneurography was performed by electromyograph Dantec Keypoint. Cardiovascular autonomic neuropathy (CAN) was assessed by ANX-3.0 method applying standard clinical tests.
CAN was found in 12.3% of NGT, 19.8% of prediabetes (13.2% of IFG and 20.6% of iIGT), and 32.2% of NDT2D. The prevalence of diabetic sensory polyneuropathy (DSPN) was 5.7% in prediabetes and 28.6% in NDT2D. The panel of age, QTc interval, waist circumference, diastolic blood pressure, and 120-min plasma glucose was related to sympathetic activity (F [5451]=78.50, p<0.001). The panel of age, waist circumference, and QTc interval was related to parasympathetic power (F [3453]=132.26, p<0.001). HbA1c and age were related to sural SNAP (F [2454]=15.12, p<0.001). HbA1c and AGEs were related to sural SNCV (F [2454]=12.18, p<0.001).
Our results demonstrate a high prevalence of autonomic and sensory nerve dysfunction in early stages of glucose intolerance. Age, postprandial glycemia, central obesity, diastolic blood pressure and QTc interval outline as predictive markers of CAN; hyperglycemia, glycation and age of DSPN.
本研究评估不同糖耐量阶段的自主神经和躯体神经功能及其与不同心脏代谢参数的相关性。
招募了478名受试者，平均年龄49.3±13.7岁，平均BMI为31.0±6.2kg/m²，根据糖耐量进行分组：130例糖耐量正常（NGT），227例糖尿病前期（125例空腹血糖受损（IFG）和102例单纯糖耐量受损（iIGT）），以及121例新诊断的2型糖尿病（NDT2D）。在口服葡萄糖耐量试验（OGTT）期间研究糖耐量。评估人体测量指标、血压、糖化血红蛋白（HbA1c）、血脂、高敏C反应蛋白（hsCRP）和白蛋白与肌酐比值。通过生物电阻抗法（InBody 720，BioSpace）估算身体成分。通过皮肤自发荧光（AGE-Reader-DiagnOpticsTM）评估组织晚期糖基化终末产物（AGEs）的积累。使用Dantec Keypoint肌电图仪进行神经电图检查。采用ANX-3.0方法并应用标准临床测试评估心血管自主神经病变（CAN）。
在NGT组中，CAN的发生率为12.3%；糖尿病前期组中为19.8%（IFG组为13.2%，iIGT组为20.6%）；NDT2D组中为32.2%。糖尿病感觉性多发性神经病变（DSPN）在糖尿病前期的患病率为5.7%，在NDT2D中为28.6%。年龄、QTc间期、腰围、舒张压和120分钟血浆葡萄糖与交感神经活动相关（F[5,451]=78.50，p<0.001）。年龄、腰围和QTc间期与副交感神经功能相关（F[3,453]=132.26，p<0.001）。HbA1c和年龄与腓肠神经感觉神经动作电位（SNAP）相关（F[2,454]=15.12，p<0.001）。HbA1c和AGEs与腓肠神经感觉神经传导速度（SNCV）相关（F[2,454]=12.18，p<0.001）。
我们的结果表明，在糖耐量异常的早期阶段，自主神经和感觉神经功能障碍的患病率很高。年龄、餐后血糖、中心性肥胖、舒张压和QTc间期可作为CAN的预测指标；高血糖、糖基化和年龄可作为DSPN的预测指标。
