Lilja B, Nosslin B, Bergström B, Sundkvist G
Diabetes Res. 1985 Jul;2(4):179-81.
Glomerular filtration rate (GFR) measured by the 51Cr-EDTA clearance method, autonomic nerve function evaluated by the heart rate reaction to deep breathing (E/I ratio) and to tilting (acceleration and brake indices), and orthostatic blood pressures were followed up after 5-7 yr in 43 patients with Type 1 diabetes. At follow up, 20 patients showed a decrease in GFR greater than expected. In the first study, these patients showed low E/I ratios and brake indices indicating vagal neuropathy, while the acceleration index fell, indicating sympathetic denervation, between the studies. Accordingly, vagal neuropathy preceded decreases in GFR and sympathetic denervation favoured deteriorations in GFR. The present report provides evidence that sympathetic denervation might be behind the development of diabetic kidney complications.
采用51铬-乙二胺四乙酸清除率法测定肾小球滤过率（GFR），通过深呼吸心率反应（E/I比值）和倾斜试验（加速和制动指数）评估自主神经功能，并对43例1型糖尿病患者进行了5至7年的随访观察其直立位血压。随访时，20例患者的GFR下降幅度超过预期。在第一项研究中，这些患者的E/I比值和制动指数较低，提示迷走神经病变，而在两项研究期间，加速指数下降，提示交感神经去神经支配。因此，迷走神经病变先于GFR下降，交感神经去神经支配则促使GFR恶化。本报告提供了证据表明交感神经去神经支配可能是糖尿病肾脏并发症发生的原因。
