Clarke B F, Ewing D J, Campbell I W
Diabetologia. 1979 Oct;17(4):195-212. doi: 10.1007/BF01235856.
This review attempts to outline the present understanding of diabetic autonomic neuropathy. The clinical features have been increasinly recognised but knowledge of the localization and morphology of the lesions and their pathogenesis remains fragmentary. A metabolic causation as postulated in somatic nerves accords best with clinical observations. Most bodily systems, particularly the cardiovascular, gastrointestinal and urogenital, are involved with added disturbances of thermoregulatory function and pupillary reflexes. Possible effects on neuroendocrine and peptidergic secretion and respiratory control await definition. Current interest centres around the development of a new generation of tests of autonomic nerve function that are simple, non-invasive, reproducible and allow precision in diagnosis and accurate quantitation. Most are based on cardiovascular reflexes and abnormality in them is assumed to reflect autonomic damage elsewhere. Probably no single test suffices and a battery of tests reflecting both parasympathetic and sympathetic function is preferable. Little is known of the natural history. The prevalence may be greater than previously suspected and although symptoms are mild in the majority, a few develop florid features. The relation of control and duration of diabetes to the onset and progression of autonomic neuropathy is not clearly established. Once tests of autonomic function become abnormal they usually remain abnormal. Symptomatic autonomic neuropathy carries a greatly increased mortality rate possibly due to indirect mechanisms such as renal failure and direct mechanisms such as cardio-resiratory arrest. Improved treatment of some of the more disabling symptoms has been possible in recent years.
本综述旨在概述目前对糖尿病自主神经病变的认识。其临床特征已得到越来越多的认识，但关于病变的定位、形态及其发病机制的知识仍不完整。与躯体神经一样，代谢原因最符合临床观察结果。大多数身体系统，尤其是心血管、胃肠和泌尿生殖系统，都会受到影响，还会出现体温调节功能和瞳孔反射的额外紊乱。对神经内分泌和肽能分泌以及呼吸控制的可能影响尚待明确。目前的研究兴趣集中在新一代自主神经功能测试的开发上，这些测试应简单、无创、可重复，并能实现精确诊断和准确量化。大多数测试基于心血管反射，其中的异常被认为反映了其他部位的自主神经损伤。可能没有单一的测试就足够了，一组反映副交感神经和交感神经功能的测试更可取。对其自然史了解甚少。其患病率可能比以前怀疑的更高，尽管大多数人的症状较轻，但少数人会出现明显的症状。糖尿病的控制情况和病程与自主神经病变的发生和进展之间的关系尚未明确确立。一旦自主神经功能测试变得异常，它们通常会一直异常。有症状的自主神经病变的死亡率大大增加，可能是由于肾衰竭等间接机制和心搏骤停等直接机制。近年来，对一些更具致残性的症状进行改善治疗已成为可能。
