Caviezel F, Bossi A, Baresi A, Salvini A
Acta Diabetol Lat. 1986 Oct-Dec;23(4):331-8. doi: 10.1007/BF02582066.
Diarrhea and/or rectal incontinence may represent a sign of autonomic neuropathy in diabetes. The present investigation was performed to study ano-rectal function and reactivity to appropriate stimuli in 20 diabetic patients with or without autonomic neuropathy (14 insulin-dependent diabetics; 6 non-insulin-dependent diabetics; mean age 39.2 years; mean duration of diabetes 12.6). Twenty-five healthy subjects (mean age 43.5 years) were studied as controls. All subjects underwent ano-rectal manometry by means of special open-ended-tip catheters connected with a 6-channel polygraph. A rectal latex balloon was inflated with 30 or 60 ml air to induce a stimulus which, under normal conditions, is apt to relax the internal sphincter and to contract the external one (ano-rectal inhibitory reflex). Eleven diabetics had symptoms and signs of autonomic neuropathy: 8 of these (73%) showed marked abnormalities of ano-rectal function (i.e. no response even to maximum stimulus or contraction of both sphincters). All non-neuropathic patients showed a normal pattern of ano-rectal manometry. A relationship between abnormal response to rectal stimulation and the presence of autonomic neuropathy involving the pelvic parasympathetic section or regional intramural plexuses may be suspected and demonstrated in diabetic neuropathic patients.
腹泻和/或大便失禁可能是糖尿病自主神经病变的一个迹象。本研究旨在探讨20例有或无自主神经病变的糖尿病患者（14例胰岛素依赖型糖尿病患者；6例非胰岛素依赖型糖尿病患者；平均年龄39.2岁；平均糖尿病病程12.6年）的肛门直肠功能及对适当刺激的反应性。25名健康受试者（平均年龄43.5岁）作为对照进行研究。所有受试者均通过与六通道测谎仪相连的特殊开口尖端导管进行肛门直肠测压。用30或60毫升空气给直肠乳胶球囊充气以诱发一种刺激，在正常情况下，这种刺激易于使内括约肌松弛并使外括约肌收缩（肛门直肠抑制反射）。11名糖尿病患者有自主神经病变的症状和体征：其中8例（73%）表现出明显的肛门直肠功能异常（即对最大刺激无反应或双括约肌均收缩）。所有无神经病变的患者肛门直肠测压模式均正常。在糖尿病神经病变患者中，可能怀疑并证实直肠刺激的异常反应与涉及盆腔副交感神经节段或局部壁内神经丛的自主神经病变之间存在关联。
