Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Neurology, Odense University Hospital, Odense, Denmark.
J Peripher Nerv Syst. 2023 Sep;28(3):450-459. doi: 10.1111/jns.12580. Epub 2023 Aug 14.
Cardiovascular autonomic neuropathy (CAN) in patients with diabetes is associated with poor prognosis. We aimed to assess signs of CAN and autonomic symptoms and to investigate the impact of sensorimotor neuropathy on CAN by examining type 2 diabetes patients with (DPN [distal sensorimotor polyneuropathy]) and without distal sensorimotor polyneuropathy (noDPN) and healthy controls (HC). Secondarily, we aimed to describe the characteristics of patients with CAN.
A population of 374 subjects from a previously described cohort of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) were included. Subjects were examined with the Vagus™ device for the diagnosis of CAN, where two or more abnormal cardiovascular autonomic reflex tests indicate definite CAN. Autonomic symptoms were assessed with Composite Autonomic Symptom Score 31 (COMPASS 31) questionnaire. DPN was defined according to the Toronto consensus panel definition.
Definite CAN was present in 22% with DPN, 7% without DPN and 3% of HC, and 91% of patients with definite CAN had DPN. Patients with DPN and definite CAN reported higher COMPASS 31 scores compared to patients with noDPN (20.0 vs. 8.3, p < 0.001) and no CAN (22.1 vs. 12.3, p = 0.01). CAN was associated with HbA1c and age in a multivariate logistic regression analysis but was not associated with IEFND or triglycerides.
One in five patients with DPN have CAN and specific CAN characteristics may help identify patients at risk for developing this severe diabetic complication. Autonomic symptoms were strongly associated with having both DPN and CAN, but too unspecific for diagnosing CAN.
糖尿病患者的心血管自主神经病变（CAN）与不良预后相关。我们旨在评估 CAN 迹象和自主症状，并通过检查伴有（远端感觉运动性多神经病[DPN]）和不伴有远端感觉运动性多神经病（noDPN）的 2 型糖尿病患者以及健康对照者（HC），研究感觉运动性神经病对 CAN 的影响。其次，我们旨在描述 CAN 患者的特征。
纳入了先前描述的丹麦 2 型糖尿病战略研究中心（DD2）队列中的 374 名受试者。使用 Vagus™设备对受试者进行 CAN 诊断检查，其中两个或更多异常的心血管自主反射测试表明存在明确的 CAN。使用复合自主症状评分 31 问卷（COMPASS 31）评估自主症状。根据多伦多共识小组的定义定义 DPN。
伴有 DPN 的患者中明确的 CAN 发生率为 22%，无 DPN 的患者为 7%，HC 为 3%，91%的明确 CAN 患者伴有 DPN。伴有 DPN 和明确 CAN 的患者报告的 COMPASS 31 评分高于无 DPN（20.0 比 8.3，p<0.001）和无 CAN（22.1 比 12.3，p=0.01）的患者。多变量逻辑回归分析显示，CAN 与 HbA1c 和年龄相关，但与 IEFND 或甘油三酯无关。
每 5 名伴有 DPN 的患者中就有 1 名患有 CAN，特定的 CAN 特征可能有助于识别发生这种严重糖尿病并发症的高危患者。自主症状与同时存在 DPN 和 CAN 强烈相关，但对诊断 CAN 特异性不足。
