Valensi P, Thi B N, Lormeau B, Pariès J, Attali J R
Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Jean Verdier, Bondy, France.
Int J Obes Relat Metab Disord. 1995 Feb;19(2):113-8.
The aim of this work was to determine the presence and prevalence of alterations in cardiac autonomic function in obese, non-diabetic subjects.
These were 121 obese people, 15 with glucose intolerance and none with diabetes, and a group of 40 healthy people.
A series of five standardized tests was carried out, three of which were based mainly on parasympathetic control (heart rate response to Valsalva, deep breathing and lying-to-standing) and two on cardiovascular sympathetic function (blood pressure response to standing and to handgrip).
The response to the deep breathing test correlated negatively with age, as it did in control subjects. At least one parasympathetic test, age-adjusted, was abnormal in 49 patients (40.5%). Five other patients had an abnormal handgrip test, and no patient had orthostatic hypotension. No correlation was found between the parasympathetic test results and sex or body mass index. Prevalence of cardiac autonomic dysfunction, considered to be present when at least one parasympathetic test was abnormal, did not differ according to a gynoid or android type of obesity. A significant negative correlation was found between heart rate response to deep breathing and fasting glycemia.
It was concluded that cardiac autonomic dysfunction evidenced by means of simple, reliable, reproducible tests is frequent in the non-diabetic obese subject. This disorder could explain the poor cardiovascular prognosis associated with obesity. Whether it is a complication of obesity or a marker associated with certain kinds of obesity (of hypothalamic origin) remains to be clarified.
本研究旨在确定肥胖非糖尿病受试者心脏自主神经功能改变的存在情况及患病率。
121名肥胖者，其中15人存在糖耐量异常，无糖尿病患者，以及40名健康人。
进行了一系列五项标准化测试，其中三项主要基于副交感神经控制（对瓦尔萨尔瓦动作、深呼吸和卧位到站立位的心率反应），两项基于心血管交感神经功能（对站立位和握力的血压反应）。
深呼吸测试的反应与年龄呈负相关，与对照组情况相同。经年龄调整后，49名患者（40.5%）至少有一项副交感神经测试异常。另外5名患者握力测试异常，无患者出现直立性低血压。副交感神经测试结果与性别或体重指数之间未发现相关性。当至少一项副交感神经测试异常时，心脏自主神经功能障碍的患病率在梨形肥胖或苹果形肥胖类型中无差异。深呼吸心率反应与空腹血糖之间存在显著负相关。
得出结论，通过简单、可靠、可重复的测试证明，非糖尿病肥胖受试者中频繁出现心脏自主神经功能障碍。这种紊乱可能解释了与肥胖相关的不良心血管预后。它是肥胖的并发症还是与某些类型肥胖（下丘脑起源）相关的标志物，仍有待阐明。
