Wieling W, Borst C, van Dongen Torman M A, van der Hofstede J W, van Brederode J F, Endert E, Dunning A J
Diabetologia. 1983 Jun;24(6):422-7. doi: 10.1007/BF00257340.
We have investigated the relationship between vagal and sympathetic lesions in 62 diabetic patients and compared the results with those from 37 healthy subjects. Vagal function was assessed by heart rate changes with forced breathing. Sympathetic control was measured by the heart rate and blood pressure changes after standing and the concomitant plasma catecholamine response. The integrity of the postganglionic sympathetic neuron was evaluated separately by testing sudomotor function. Impaired sympathetic control was found only in 15 diabetic patients with severely impaired or absent vagal heart rate control. In 12 patients the chief abnormalities consisted of a delayed and diminished heart rate increase, an excessive fall in systolic blood pressure (greater than 20 mmHg) in combination with an abnormally small noradrenaline increment (less than 120 ng/l) and a lesion of the postganglionic sympathetic neuron. Three patients with severely impaired parasympathetic heart rate control in combination with an intact postganglionic sympathetic neuron demonstrated a large noradrenaline increase on standing (greater than 700 ng/l). Measurement of vagal heart rate control and testing of sudomotor function makes it possible to classify a spectrum of abnormal cardiovascular responses to standing in diabetic patients.
我们研究了62例糖尿病患者迷走神经和交感神经病变之间的关系，并将结果与37名健康受试者的结果进行了比较。通过强迫呼吸时的心率变化评估迷走神经功能。通过站立后的心率和血压变化以及伴随的血浆儿茶酚胺反应来测量交感神经控制。通过测试汗腺运动功能分别评估节后交感神经元的完整性。仅在15例迷走神经心率控制严重受损或缺失的糖尿病患者中发现交感神经控制受损。在12例患者中，主要异常包括心率增加延迟和减弱、收缩压过度下降（大于20 mmHg），同时去甲肾上腺素增量异常小（小于120 ng/l）以及节后交感神经元病变。3例副交感神经心率控制严重受损且节后交感神经元完整的患者在站立时去甲肾上腺素大幅增加（大于700 ng/l）。测量迷走神经心率控制和测试汗腺运动功能使得对糖尿病患者站立时一系列异常心血管反应进行分类成为可能。
