Watkins P J, Edmonds M E
Diabetologia. 1983 Aug;25(2):73-7. doi: 10.1007/BF00250890.
Sympathetic damage is a striking feature of diabetic neuropathy, probably much more common and important than previously suspected. Degeneration of arterial medial smooth muscle with subsequent medial calcification is a feature of diabetic neuropathy and represents a structural abnormality probably resulting from sympathetic denervation. Loss of vasomotor control is responsible not only for postural hypotension but also for the remarkable increase of peripheral blood flow and arteriovenous shunting in the neuropathic foot. Demineralisation of bones and neuroarthropathic bone and joint destruction may result. Intractable oedema is another consequence of these haemodynamic abnormalities, while in other cases there is a close association of sympathetic defects with painful neuropathies. The possibility of new treatments using sympathomimetic agents to reverse these abnormalities now exists, and ephedrine has already been shown to be highly effective in reducing neuropathic oedema.
交感神经损伤是糖尿病性神经病变的一个显著特征，可能比之前怀疑的更为常见且重要。动脉中层平滑肌变性并随后发生中层钙化是糖尿病性神经病变的一个特征，代表了一种可能由交感神经去神经支配导致的结构异常。血管舒缩控制丧失不仅导致体位性低血压，还导致神经病变足部外周血流量显著增加以及动静脉分流。可能会导致骨质脱矿以及神经性关节病性骨与关节破坏。顽固性水肿是这些血流动力学异常的另一个后果，而在其他情况下，交感神经缺陷与疼痛性神经病变密切相关。现在存在使用拟交感神经药来逆转这些异常的新治疗方法的可能性，并且麻黄碱已被证明在减轻神经病变性水肿方面非常有效。
