Pan Qi, Li Quanmin, Deng Wei, Zhao Dong, Qi Lin, Huang Wei, Ma Li, Li Hongmei, Li Yufeng, Lyu Xiaofeng, Wang Aihong, Yao Hebin, Guo Lixin, Xing Xiaoyan
Department of Endocrinology, National Center of Gerontology, Beijing Hospital, Beijing, China.
The PLA Rocket Force Characteristic Medical Center, Beijing, China.
Front Neurosci. 2019 Oct 25;13:1144. doi: 10.3389/fnins.2019.01144. eCollection 2019.
Cardiovascular autonomic neuropathy (CAN) is a debilitating condition occurring among diabetic patients especially those with long duration of disease. Whereas incidences and treatment of CAN has been well described for Western populations, fewer studies have been conducted among the Chinese. This study, therefore, aimed to assess the prevalence of CAN among sampled Chinese diabetic patients. Accordingly, 2,048 participants with a history of type 1 diabetes mellitus (T1DM, 73) and type 2 diabetes mellitus (T2DM, 1975) were randomly sampled from 13 hospitals. Patients' biodata were recorded, and autonomic nervous system function tests performed to aid in the preliminary diagnosis of CAN. The final CAN diagnosis was based on the Ewing's test in which heart rate variation (HRV) values were evaluated through deep-breathing (DB), lying-to-standing (LS), and Valsalva (V) tests. Systolic blood pressure (SBP) variation values were also evaluated through LS. In the T1DM group, 61.6% patients were diagnosed with CAN and no differences were observed in the baseline and clinical data between this group and those without CAN ( > 0.05). In the T2DM group, 62.6% patients were diagnosed with CAN and statistically significant differences were found between the CAN and non- CAN group with regards to age, duration of diabetes, metformin treatment, retinopathy, and hypertension history ( < 0.05). The most common manifestations of CAN included weakness (28.6%), dizziness (23.4%), frequent urination (19.6%), upper body sweating (18.3%), and nocturia (15.9%). Additionally, duration of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. On diagnosis, a combination of the V test + LS test provided the highest sensitivity of detecting CAN among T1DM group (sensitivity = 97.6%, AUC = 0.887) while for T2DM category, DB test had the highest sensitivity (83.6%), and maximal AUC (0.856) was found with V test + DB test. The overall prevalence of diabetes with CAN in the study was up to 63%.
心血管自主神经病变（CAN）是糖尿病患者尤其是病程较长患者中出现的一种使人衰弱的病症。虽然西方人群中CAN的发病率及治疗方法已有详尽描述，但针对中国人的相关研究较少。因此，本研究旨在评估抽样的中国糖尿病患者中CAN的患病率。据此，从13家医院随机抽取了2048名有1型糖尿病（T1DM，73例）和2型糖尿病（T2DM，1975例）病史的参与者。记录患者的生物数据，并进行自主神经系统功能测试以辅助CAN的初步诊断。最终的CAN诊断基于尤因测试，通过深呼吸（DB）、平卧位到站立位（LS）和瓦尔萨尔瓦动作（V）测试评估心率变异性（HRV）值。还通过LS评估收缩压（SBP）变异性值。在T1DM组中，61.6%的患者被诊断为CAN，该组与未患CAN的患者在基线和临床数据方面未观察到差异（P>0.05）。在T2DM组中，62.6%的患者被诊断为CAN，CAN组与非CAN组在年龄、糖尿病病程、二甲双胍治疗、视网膜病变和高血压病史方面存在统计学显著差异（P<0.05）。CAN最常见的表现包括乏力（28.6%）、头晕（23.4%）、尿频（19.6%）、上身出汗（18.3%）和夜尿（15.9%）。此外，病程和年龄分别是T1DM和T2DM中CAN的独立危险因素。诊断时，V测试+LS测试组合在T1DM组中检测CAN的灵敏度最高（灵敏度=97.6%，AUC=0.887），而对于T2DM类别，DB测试灵敏度最高（83.6%），V测试+DB测试的AUC最大（0.856）。本研究中糖尿病合并CAN的总体患病率高达63%。
