Ewing D J, Campbell I W, Clarke B F
Q J Med. 1980 Winter;49(193):95-108.
Seventy-three diabetics (62 males and 11 females) who complained of symptoms suggestive of autonomic neuropathy were followed prospectively for up to five years. Thirty patients presented with impotence alone, while the other 43 presented with one or more of the following: postural hypotension, intermittent diarrhoea, hypoglycaemic unawareness, sweating abnormalities and gastric fullness. Most subjects with impotence alone had normal autonomic function tests (responses to the Valsalva manoeuvre and sustained handgrip) whereas the majority with other symptoms had abnormal tests. Twenty-six subjects (20 males and six females) died during the follow-up period. Of the 33 with initially normal autonomic function tests, five (15 per cent) died, whereas of the 40 with initially abnormal tests, 21 (53 per cent) died. Diabetics with symptoms of autonomic neuropathy and abnormal autonomic function tests, had a calculated mortality rate after two-and-a-half years of 44 per cent and after five years of 56 per cent. Half the deaths in those with abnormal tests were from renal failure, and the remainder were either sudden and unexpected, or from other causes which may have been associated with the autonomic neuropathy. Autonomic function testing repeated during the follow-up period showed that some normal tests later became abnormal, but once tests were abnormal, they usually remained abnormal. A number of subjects with impotence alone developed other features of autonomic neuropathy and abnormal tests during the follow up period. Symptoms of autonomic neuropathy, particularly postural hypotension, gastric symptoms and hypoglycaemic unawareness, together with abnormal autonomic function tests, carry a very poor prognosis. Diarrhoea and importence, on their own, cannot be relied on as symptoms of autonomic neuropathy. Autonomic function testing using simple cardiovascular reflexes give a good guide to the prognosis of diabetic autonomic neuropathy.
73例主诉有自主神经病变症状的糖尿病患者（62例男性，11例女性）接受了长达5年的前瞻性随访。30例患者仅表现为阳痿，另外43例患者表现出以下一种或多种症状：体位性低血压、间歇性腹泻、低血糖无知觉、出汗异常和胃部饱胀感。大多数仅患有阳痿的患者自主神经功能测试（对瓦尔萨尔瓦动作和持续握力的反应）正常，而大多数有其他症状的患者测试异常。26例患者（20例男性，6例女性）在随访期间死亡。最初自主神经功能测试正常的33例患者中，5例（15%）死亡，而最初测试异常的40例患者中，21例（53%）死亡。有自主神经病变症状且自主神经功能测试异常的糖尿病患者，在2.5年后的计算死亡率为44%，5年后为56%。测试异常患者中一半的死亡原因是肾衰竭，其余要么是突然意外死亡，要么是与自主神经病变可能相关的其他原因。随访期间重复进行的自主神经功能测试表明，一些正常测试后来变为异常，但一旦测试异常，通常会持续异常。许多仅患有阳痿的患者在随访期间出现了自主神经病变的其他特征和测试异常。自主神经病变的症状，尤其是体位性低血压、胃部症状和低血糖无知觉，以及异常的自主神经功能测试，预后很差。腹泻和阳痿本身不能作为自主神经病变的可靠症状。使用简单心血管反射进行的自主神经功能测试可为糖尿病自主神经病变的预后提供良好指导。
