Agashe Shruti, Petak Steven
HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.
Methodist Debakey Cardiovasc J. 2018 Oct-Dec;14(4):251-256. doi: 10.14797/mdcj-14-4-251.
Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed condition in patients with diabetes. The prevalence can range from 2.5% (based on the primary prevention cohort in the Diabetes Control and Complications Trial) to as high as 90% of patients with type 1 diabetes. Clinical manifestations range from orthostasis to myocardial infarction. The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function. The pathophysiology of CAN is complex, likely multifactorial, and not completely understood. Treatment is limited to symptomatic control of orthostatic hypotension, which is a late complication, and current strategies to reverse CAN are limited. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and complications of CAN as well as current treatment options.
心血管自主神经病变（CAN）是糖尿病患者中一种严重致残但诊断不足的病症。其患病率范围从2.5%（基于糖尿病控制与并发症试验中的一级预防队列）到高达90%的1型糖尿病患者。临床表现从直立性低血压到心肌梗死不等。诊断通过多种自主神经功能测试来评估交感神经和副交感神经功能。CAN的病理生理学很复杂，可能是多因素的，尚未完全了解。治疗仅限于对直立性低血压这一晚期并发症的症状控制，目前逆转CAN的策略有限。本综述探讨了CAN的流行病学、病理生理学、临床表现、诊断、并发症以及当前的治疗选择。
