Karavanaki K, Davies A G, Hunt L P, Morgan M H, Baum J D
Institute of Child Health, Royal Hospital for Sick Children, Bristol.
Arch Dis Child. 1994 Dec;71(6):511-5. doi: 10.1136/adc.71.6.511.
Sympathetic function was studied in 101 diabetic children and 102 age and sex matched control children, as part of a longitudinal study of the evolution of microvascular disease in the population of diabetic children and adolescents in Avon County. The median (range) age of the diabetic population was 13.5 (6.0-17.2) years, the duration of diabetes was 4.0 (0.4-13.9) years, and glycated haemoglobin (HbA1) was 10.9 (7.0-18.1)%. Pupillary adaptation in darkness, as an index of sympathetic neuropathy, was measured using a Polaroid portable pupillometer. Diabetic children had a significantly smaller median pupillary diameter, measured as the pupil/iris ratio and expressed as a percentage, than control children (median (range) 62.9 (50.3-72.1) v 65.9 (52.2-73.8)). Pupillary diameter was significantly related to diabetes duration (r = -0.22), HbA1 (r = -0.34), systolic blood pressure (r = -0.25), diastolic blood pressure (r = -0.49), and mean albumin/creatinine ratio on random urine samples (r = -0.26). Pupillary diameter was not related to age (r = -0.1). Eight (7.9%) diabetic and four (3.9%) control children were identified as having abnormal pupillary dilation in darkness. In comparison with the rest of the diabetic population, these diabetic children had longer diabetes duration and poorer glycaemic control. Polaroid pupillometry has demonstrated subclinical autonomic neuropathy in a population of diabetic children and adolescents. These abnormalities were related to poor metabolic control, long diabetes duration, and also to other indices of microvascular disease.
作为对埃文郡糖尿病儿童和青少年人群微血管疾病演变的纵向研究的一部分，对101名糖尿病儿童和102名年龄及性别匹配的对照儿童的交感神经功能进行了研究。糖尿病患者的年龄中位数（范围）为13.5（6.0 - 17.2）岁，糖尿病病程为4.0（0.4 - 13.9）年，糖化血红蛋白（HbA1）为10.9（7.0 - 18.1）%。使用宝丽来便携式瞳孔计测量黑暗中瞳孔的适应性，以此作为交感神经病变的指标。糖尿病儿童的瞳孔直径中位数（以瞳孔/虹膜比率测量并以百分比表示）明显小于对照儿童（中位数（范围）62.9（50.3 - 72.1）对65.9（52.2 - 73.8））。瞳孔直径与糖尿病病程（r = -0.22）、HbA1（r = -0.34）、收缩压（r = -0.25）、舒张压（r = -0.49）以及随机尿样中的平均白蛋白/肌酐比率（r = -0.26）显著相关。瞳孔直径与年龄无关（r = -0.1）。8名（7.9%）糖尿病儿童和4名（3.9%）对照儿童被确定在黑暗中瞳孔扩张异常。与其他糖尿病患者相比，这些糖尿病儿童的糖尿病病程更长，血糖控制更差。宝丽来瞳孔测量法已在糖尿病儿童和青少年人群中证实存在亚临床自主神经病变。这些异常与代谢控制不佳、糖尿病病程长以及微血管疾病的其他指标有关。
