Kikuchi N, Nanno M, Kurahachi H, Yoshimi T
Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Nihon Naibunpi Gakkai Zasshi. 1988 Feb 20;64(2):93-108. doi: 10.1507/endocrine1927.64.2_93.
Autonomic neuropathy is one of the complications of diabetes. Recently, several authors reported that measuring R-R interval variation of ECG is a noninvasive and useful method for testing parasympathetic function. However, there were few reports about sympathetic function in diabetics. In order to evaluate sympathetic function in diabetics quantitatively, we studied the responses of plasma norepinephrine (NE), epinephrine (E) and related factors after 60 min bed rest and sequentially during 10 min of upright posture and 5 min handgrip while still upright. We also studied the responses of NE and E during 5 min smoking in supine position. Subjects were divided into four age-matched groups. These were 15 normal subjects (Group I), 20 diabetics without complications (Group II), 20 diabetics with peripheral neuropathy but no autonomic symptoms (Group III) and 15 diabetics with autonomic symptoms (Group IV). We also studied R-R interval variation (CV: Coefficient of Variation) as a parameter of parasympathetic function and compared this with sympathetic function. Upon standing, blood pressure (BP) dropped precipitously in Group IV, whereas no significant changes were observed in the other three groups. Heart rate (HR) increased in Groups I and II, but not in Groups III and IV. During handgrip, BP and HR did not change significantly in all groups. Basal NE levels in Group IV were significantly smaller than those in Group I. NE responses to both standing and handgrip stimuli were markedly reduced in Group IV and, even in Group III, increments were significantly smaller than those in Groups I and II. Basal E levels did not differ, and significant changes were not observed after standing and handgrip in all groups. Both plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) in Groups III and IV were lower than those in Groups I and II at rest and standing. After smoking, both BP and HR increased significantly in Groups I, II and III, whereas no changes were observed in Group IV. Both NE and E responses were markedly reduced in Group IV and, even in Group III, responses were significantly smaller than those in Groups I and II. CV in Groups III and IV were significantly smaller than those in Groups I and II. In diabetics, CV was strongly correlated with NE increments after standing (r = 0.78, p less than 0.01). Also, CV was correlated with both NE and E increments after smoking (r = 0.71 (NE), r = 0.82 (E), p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)
自主神经病变是糖尿病的并发症之一。最近，几位作者报告称，测量心电图的R-R间期变化是一种检测副交感神经功能的无创且有用的方法。然而，关于糖尿病患者交感神经功能的报道较少。为了定量评估糖尿病患者的交感神经功能，我们研究了60分钟卧床休息后，以及随后在直立姿势10分钟和直立状态下进行5分钟握力试验期间血浆去甲肾上腺素（NE）、肾上腺素（E）及相关因子的反应。我们还研究了仰卧位吸烟5分钟期间NE和E的反应。受试者被分为四个年龄匹配组。分别是15名正常受试者（I组）、20名无并发症的糖尿病患者（II组）、20名有周围神经病变但无自主神经症状的糖尿病患者（III组）和15名有自主神经症状的糖尿病患者（IV组）。我们还研究了R-R间期变化（CV：变异系数）作为副交感神经功能的参数，并将其与交感神经功能进行比较。站立时，IV组血压（BP）急剧下降，而其他三组未观察到明显变化。I组和II组心率（HR）增加，而III组和IV组未增加。握力试验期间，所有组的BP和HR均无明显变化。IV组的基础NE水平显著低于I组。IV组对站立和握力刺激的NE反应明显降低，甚至III组的增加幅度也显著小于I组和II组。基础E水平无差异，所有组站立和握力后均未观察到明显变化。III组和IV组在静息和站立时的血浆肾素活性（PRA）和血浆醛固酮浓度（PAC）均低于I组和II组。吸烟后，I组、II组和III组的BP和HR均显著升高，而IV组未观察到变化。IV组的NE和E反应均明显降低，甚至III组的反应也显著小于I组和II组。III组和IV组的CV显著小于I组和II组。在糖尿病患者中，CV与站立后NE的增加显著相关（r = 0.78，p < 0.01）。此外，CV与吸烟后NE和E的增加均相关（r = 0.71（NE），r = 0.82（E），p < 0.01）。（摘要截选至400字）
