Ewing D J, Campbell I W, Clarke B F
Lancet. 1976 Mar 20;1(7960):601-3. doi: 10.1016/s0140-6736(76)90413-x.
Thirty-seven diabetics with symptoms and clinical features suggestive of autonomic neuropathy were followed up for 33 months. Of the twenty with abnormal Valsalva or handgrip tests initially, ten (50%) died. There were no other features at presentation that differentiated those who subsequently died from those who survived. The causes of death were renal failure (six patients), cerebrovascular accident (two patients), hypoglycaemic coma (one patient), and "sudden death" (one patient). Of the survivors whose autonomic-function tests were repeated 18 months to 2 years later, five had new or worsening symptoms of autonomic neuropathy with corresponding deterioration of their autonomic-function tests; while two, with initially normal tests, had improved symptomatically. It is concluded that in diabetics with the clinical features of autonomic neuropathy simple autonomic-function tests give a good guide to prognosis, and that abnormal tests are associated with a high mortality.
37名有自主神经病变症状和临床特征的糖尿病患者接受了33个月的随访。最初20名瓦尔萨尔瓦动作或握力试验异常的患者中，10名（50%）死亡。就诊时没有其他特征能区分随后死亡的患者和存活的患者。死亡原因包括肾衰竭（6例患者）、脑血管意外（2例患者）、低血糖昏迷（1例患者）和“猝死”（1例患者）。在18个月至2年后重复进行自主神经功能测试的存活患者中，5名出现了自主神经病变的新症状或症状加重，同时自主神经功能测试相应恶化；而2名最初测试正常的患者症状有所改善。结论是，对于有自主神经病变临床特征的糖尿病患者，简单的自主神经功能测试能很好地指导预后，测试异常与高死亡率相关。
