Faerman I, Faccio E, Milei J, Nuñez R, Jadzinsky M, Fox D, Rapaport M
Diabetes. 1977 Dec;26(12):1147-58. doi: 10.2337/diab.26.12.1147.
Myocardial infarction is considered the prime cause of death among adult diabetic patients. In a great number of cases, during myocardial infarction the patients don't feel pain or it is atypical. Diagnosis can be neglected, and mortality increases. In search of an explanation for the absence of pain in these patients, the authors studied the autonomic nerve fibers of the heart muscle with argentic and combined techniques, looking for lesions in the sympathetic or parasympathetic nerve fibers that conduct pain. In the five cases of painless myocardial infarction studied, the nerve fibers showed typical lesions of diabetic neuropathy: beaded thickenings, spindle-shaped thickenings, fragmentation of fibers, and diminution of the number of fibers in the nerves. The patients in the control group (five diabetics with painful infarction, five diabetics with infarction, five nondiabetics with painful infarction, and five nondiabetics without infarction) had no lesions. These facts led us to assume that the absence of pain in diabetics with myocardial infarction could be due to a lesion of the afferent nerves that conduct pain.
心肌梗死被认为是成年糖尿病患者死亡的主要原因。在大量病例中，心肌梗死期间患者没有疼痛感或疼痛不典型。诊断可能被忽视，死亡率会增加。为了寻找这些患者无痛的原因，作者用银染和联合技术研究了心肌的自主神经纤维，寻找传导疼痛的交感或副交感神经纤维中的病变。在所研究的5例无痛性心肌梗死病例中，神经纤维显示出糖尿病性神经病变的典型病变：串珠样增厚、纺锤形增厚、纤维断裂以及神经中纤维数量减少。对照组的患者（5例有疼痛性梗死的糖尿病患者、5例有梗死的糖尿病患者、5例有疼痛性梗死的非糖尿病患者和5例无梗死的非糖尿病患者）没有病变。这些事实使我们认为，糖尿病患者心肌梗死时无痛可能是由于传导疼痛的传入神经病变所致。
