Hoeldtke R D, Cilmi K M
J Clin Endocrinol Metab. 1984 Aug;59(2):246-52. doi: 10.1210/jcem-59-2-246.
Orthostatic hypotension (OH) in patients with diabetic autonomic neuropathy may result from sympathetic neuronal dysfunction and inadequate norepinephrine (NE) release as patients shift from the supine to an upright posture. The biochemical basis for this physiological abnormality is not understood. We measured basal supine NE secretion and production in 10 diabetic patients with OH, 9 diabetic patients without OH, and in 13 age-matched normal subjects. Apparent NE secretion, the rate at which NE enters the bloodstream, was 1.22 +/- 0.24 (SEM) nmol/m2 X min in the diabetic patients with OH, significantly lower than in the diabetic patients without OH and normal subjects in whom apparent NE secretion rates were 2.27 +/- 0.48 and 1.86 +/- 0.12 nmol/m2 X min, respectively. NE production, estimated from integrated NE metabolite excretion, was 10.2 +/- 0.85 nmol/mg creatinine in the diabetic patients with OH, which was significantly lower (P less than 0.01) than that in the diabetic patients without OH and normal subjects in whom NE production was 14.8 +/- 1.8 and 16.9 +/- 1.2 nmol/mg creatinine, respectively. These data demonstrate that supine basal apparent NE secretion and NE production are decreased in patients with OH secondary to diabetic autonomic neuropathy.
糖尿病自主神经病变患者发生直立性低血压（OH），可能是由于患者从仰卧位转为直立姿势时，交感神经元功能障碍以及去甲肾上腺素（NE）释放不足所致。这种生理异常的生化基础尚不清楚。我们对10例患有OH的糖尿病患者、9例未患OH的糖尿病患者以及13名年龄匹配的正常受试者测量了仰卧位基础NE分泌和生成情况。患有OH的糖尿病患者中，NE进入血液的速率即表观NE分泌为1.22±0.24（SEM）nmol/m²·min，显著低于未患OH的糖尿病患者和正常受试者，后两者的表观NE分泌速率分别为2.27±0.48和1.86±0.12 nmol/m²·min。根据NE代谢产物排泄总量估算的NE生成量，在患有OH的糖尿病患者中为10.2±0.85 nmol/mg肌酐，显著低于（P<0.01）未患OH的糖尿病患者和正常受试者，后两者的NE生成量分别为14.8±1.8和16.9±1.2 nmol/mg肌酐。这些数据表明，继发于糖尿病自主神经病变的OH患者，仰卧位基础表观NE分泌和NE生成均减少。
