Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca.
National Centre for Healthcare Research and Pharmacoepidemiology.
J Hypertens. 2020 Aug;38(8):1436-1442. doi: 10.1097/HJH.0000000000002431.
Microneurographic recordings of muscle sympathetic nerve activity (MSNA) have shown that sympathetic activation may characterize diabetes mellitus. However, it is recognized that comorbidities and metabolic abnormalities frequently associated with both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) diabetes affect MSNA, generating potential confounding effects and making the association between sympathetic activation and diabetes mellitus still a controversial matter.
The present meta-analysis evaluated 11 microneurographic studies enrolling 314 diabetes mellitus patients and healthy controls, and MSNA was chosen as the main variable of interest. Collection of the data included indirect adrenergic markers such as heart rate and venous plasma noradrenaline, together with hemodynamic, anthropometric and metabolic variables.
A total of 11 microneurographic studies were evaluated including 314 diabetes mellitus patients and controls. Diabetes mellitus displayed MSNA significantly greater than controls (mean difference amounting to 8.1, 95% confidence interval 1.21-15.08, P < 0.05). This difference was ascribed to T2DM, since T1DM patients displayed MSNA values superimposable to controls. In T2DM MSNA was directly related to age (r = 0.83, β = 0.82, P < 0.04) and plasma insulin (r = 1.00, β = 2.25, P < 0.01) but not to other variables.
T2DM-related sympathetic activation is detectable even when obesity, hypertension and metabolic syndrome are excluded; not found in T1DM; not associated with anthropometric and hemodynamic variables; and related to plasma insulin.
肌肉交感神经活动（MSNA）的微神经记录显示，交感神经激活可能是糖尿病的特征。然而，人们认识到，1 型糖尿病（T1DM）和 2 型糖尿病（T2DM）患者常同时伴有合并症和代谢异常，这些异常会影响 MSNA，从而产生潜在的混杂效应，使交感神经激活与糖尿病之间的关联仍然存在争议。
本荟萃分析评估了 11 项纳入 314 例糖尿病患者和健康对照者的微神经记录研究，MSNA 被选为主要感兴趣变量。数据收集包括间接肾上腺素能标志物，如心率和静脉血浆去甲肾上腺素，以及血流动力学、人体测量学和代谢变量。
共评估了 11 项微神经记录研究，包括 314 例糖尿病患者和对照组。糖尿病患者的 MSNA 明显高于对照组（平均差值为 8.1，95%置信区间 1.21-15.08，P<0.05）。这种差异归因于 T2DM，因为 T1DM 患者的 MSNA 值与对照组重叠。在 T2DM 中，MSNA 与年龄直接相关（r=0.83，β=0.82，P<0.04）和血浆胰岛素（r=1.00，β=2.25，P<0.01），但与其他变量无关。
即使排除肥胖、高血压和代谢综合征，也能检测到与 T2DM 相关的交感神经激活；在 T1DM 中未发现；与人体测量学和血流动力学变量无关；与血浆胰岛素有关。
