Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, United States.
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Cardiol J. 2022;29(2):272-283. doi: 10.5603/CJ.a2020.0064. Epub 2020 May 7.
Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus (DM) that is associated with increased mortality. Exercise-based assessment of autonomic function has identified diminished parasympathetic reactivation after exercise in type 2 DM. It is postulated herein, that this would be more prominent among those with type 1 DM.
Sixteen subjects with type 1 DM (age 32.9 ± 10.1 years), 18 subjects with type 2 DM (55.4 ± 8.0 years) and 30 controls (44.0 ± 11.6 years) underwent exercise-based assessment of autonomic function. Two 16-min submaximal bicycle tests were performed followed by 45 min of recovery. On the second test, atropine (0.04 mg/kg) was administered near end-exercise so that all of the recovery occurred under parasympathetic blockade. Plasma epinephrine and norepinephrine levels were measured at rest, during exercise, and during recovery.
There were no differences in resting or end-exercise heart rates in the three groups. Parasympathetic effect on RR-intervals during recovery (p < 0.03) and heart rate recovery (p = 0.02) were blunted in type 2 DM. Type 1 DM had higher baseline epinephrine and norepinephrine levels (p < 0.03), and exhibited persistent sympathoexcitation during recovery.
Despite a longer duration of DM in the study patients with type 1 versus type 2 DM, diminished parasympathetic reactivation was not noted in type 1 DM. Instead, elevation in resting plasma catecholamines was noted compared to type 2 DM and controls. The variable pathophysiology for exercise-induced autonomic abnormalities in type 1 versus type 2 DM may impact prognosis.
心脏自主神经病变（CAN）是糖尿病（DM）的一种并发症，与死亡率增加有关。基于运动的自主功能评估已经确定，2 型糖尿病患者在运动后副交感神经的再激活减少。本文推测，1 型糖尿病患者中这种情况更为明显。
16 名 1 型糖尿病患者（年龄 32.9 ± 10.1 岁）、18 名 2 型糖尿病患者（55.4 ± 8.0 岁）和 30 名对照者（44.0 ± 11.6 岁）接受了基于运动的自主功能评估。进行了两次 16 分钟的次最大自行车测试，然后进行 45 分钟的恢复。在第二次测试中，在接近运动结束时给予阿托品（0.04mg/kg），以便在副交感神经阻断下进行所有恢复。在休息时、运动时和恢复时测量血浆肾上腺素和去甲肾上腺素水平。
三组患者的静息心率或运动结束时心率均无差异。在 2 型糖尿病中，恢复期间 RR 间期的副交感神经作用（p < 0.03）和心率恢复（p = 0.02）减弱。1 型糖尿病的基础肾上腺素和去甲肾上腺素水平较高（p < 0.03），并在恢复期间持续表现出交感神经兴奋。
尽管研究中的 1 型糖尿病患者的糖尿病病程较长，但在 1 型糖尿病中并未发现副交感神经再激活减弱。相反，与 2 型糖尿病和对照组相比，静息血浆儿茶酚胺水平升高。1 型糖尿病与 2 型糖尿病运动引起的自主神经异常的不同病理生理学可能影响预后。
