Sobotka P A, Liss H P, Vinik A I
J Clin Endocrinol Metab. 1986 Apr;62(4):658-63. doi: 10.1210/jcem-62-4-658.
The mortality of diabetic patients with autonomic neuropathy (DAN) is higher than that in those without autonomic neuropathy (DM). To test the hypothesis that this may be due to respiratory rather than cardiac dysfunction, we evaluated ventilatory responses to isocapnic-hypoxic and hyperoxic-hypercapnic conditions in 14 diabetic patients (8 DAN and 6 DM) and compared the results with those in 8 normal subjects. In all groups tested there was a significant linear correlation between end-tidal CO2 and minute ventilation and between end-tidal CO2 and mouth occlusion pressure (p100), as an index of the drive to breathe. There were no significant differences between the slopes and intercepts in the groups tested. A significant linear correlation was found between the O2 saturation and both minute ventilation and p100. There were no significant differences in the relationship between minute ventilation and O2 saturation, but the slopes and the intercepts of the regression lines of p100 vs. O2 saturation were significantly different in the DAN compared with those in normal subjects and DM. Additionally, five of eight patients with DAN lost their ventilatory drive and ventilatory responses to hypoxemia compared with only one of six DM. These findings suggest that a disorder in the ventilatory response to hypoxemia exists in some DAN.
患有自主神经病变的糖尿病患者（DAN）的死亡率高于无自主神经病变的糖尿病患者（DM）。为了验证这可能是由于呼吸功能障碍而非心脏功能障碍的假说，我们评估了14例糖尿病患者（8例DAN和6例DM）对等碳酸血症-低氧血症和高氧血症-高碳酸血症情况的通气反应，并将结果与8名正常受试者的结果进行比较。在所有测试组中，呼气末二氧化碳与分钟通气量之间以及呼气末二氧化碳与作为呼吸驱动力指标的口腔阻断压（p100）之间均存在显著的线性相关性。测试组之间的斜率和截距无显著差异。在氧饱和度与分钟通气量和p100之间均发现显著的线性相关性。分钟通气量与氧饱和度之间的关系无显著差异，但与正常受试者和DM相比，DAN中p100与氧饱和度回归线的斜率和截距显著不同。此外，8例DAN患者中有5例失去了通气驱动力和对低氧血症的通气反应，而6例DM患者中只有1例如此。这些发现表明，部分DAN患者存在对低氧血症通气反应的紊乱。
