Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 135-710, Republic of Korea.
Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Cardiovasc Diabetol. 2019 Mar 11;18(1):29. doi: 10.1186/s12933-019-0830-4.
Cardiovascular autonomic neuropathy (CAN) is a major cause of morbidity and mortality in diabetes patients. Although several risk factors for CAN progression have been established, whether CAN is reversible remains unclear and the clinical factors associated with CAN recovery have not been identified. This study aimed to determine clinical factors related to CAN recovery.
Type 2 diabetes patients with CAN but free of cardiovascular disease at baseline were enrolled and followed for 2-3 years in this retrospective longitudinal study. CAN was classified as early (one abnormal parasympathetic test), definite (two or more abnormal parasympathetic tests), severe (definite plus orthostatic hypotension), or atypical (early plus orthostatic hypotension or orthostatic hypotension alone) based on Ewing's method. CAN recovery was classified as partial or complete: Partial recovery was defined as one-step improvement in CAN stage (early to normal, definite to early, or severe to definite), including the disappearance of only one abnormal result in any stage. Complete recovery was defined as normalization from definite or severe CAN.
Among 759 subjects with CAN, 29.9% (n = 227) experienced CAN recovery, and 1.2% (n = 9) recovered completely. In a multivariate model, younger age (odds ratio [OR] per 5-year decrease 1.49; 95% confidence interval [CI] 1.25-1.78, P < 0.001), shorter duration of diabetes (OR per 5-year decrease 1.33; 95% CI 1.05-1.67, P = 0.016), presence of micro/macroalbuminuria (OR 0.34; 95% CI 0.15-0.78, P = 0.011), body weight reduction (OR per 1-kg decrease 1.11; 95% CI 1.02-1.21, P = 0.016), and HbA1c reduction (OR per 1% decrease 1.32; 95% CI 1.05-1.67, P = 0.019) were significantly associated with composite events of partial and complete CAN recovery. Age had the highest relative significance among the associated clinical factors. In addition, younger age was the only significant factor in complete CAN recovery.
Younger age was the most important factor in CAN recovery in subjects with type 2 diabetes, including recovery from the definite or severe stage. HbA1c reduction, body weight reduction, no concurrent micro/macroalbuminuria, and shorter duration of diabetes were also significantly associated with CAN recovery.
心血管自主神经病变（CAN）是糖尿病患者发病和死亡的主要原因。尽管已经确定了 CAN 进展的几个危险因素，但 CAN 是否可逆仍不清楚，与 CAN 恢复相关的临床因素也尚未确定。本研究旨在确定与 CAN 恢复相关的临床因素。
本回顾性纵向研究纳入了基线时患有 CAN 但无心血管疾病的 2 型糖尿病患者，并随访 2-3 年。根据 Ewing 方法，CAN 分为早期（一项异常副交感神经测试）、明确（两项或更多异常副交感神经测试）、严重（明确加直立性低血压）或非典型（早期加直立性低血压或仅直立性低血压）。CAN 恢复分为部分或完全：部分恢复定义为 CAN 阶段的一步改善（早期至正常、明确至早期或严重至明确），包括任何阶段仅一项异常结果的消失。完全恢复定义为明确或严重 CAN 的正常化。
在 759 名患有 CAN 的患者中，29.9%（n=227）经历了 CAN 恢复，1.2%（n=9）完全恢复。在多变量模型中，年龄较小（每减少 5 岁的优势比 [OR] 为 1.49；95%置信区间 [CI] 为 1.25-1.78，P<0.001）、糖尿病病程较短（每减少 5 年的 OR 为 1.33；95%CI 为 1.05-1.67，P=0.016）、存在微量/大量白蛋白尿（OR 为 0.34；95%CI 为 0.15-0.78，P=0.011）、体重减轻（每减少 1 公斤的 OR 为 1.11；95%CI 为 1.02-1.21，P=0.016）和 HbA1c 降低（每降低 1%的 OR 为 1.32；95%CI 为 1.05-1.67，P=0.019）与部分和完全 CAN 恢复的复合事件显著相关。在相关临床因素中，年龄的相对重要性最高。此外，年龄较小是完全 CAN 恢复的唯一显著因素。
在 2 型糖尿病患者中，年龄是 CAN 恢复的最重要因素，包括从明确或严重阶段的恢复。HbA1c 降低、体重减轻、无并发微量/大量白蛋白尿以及糖尿病病程较短也与 CAN 恢复显著相关。
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