Donaghue K C, Fung A T, Fairchild J M, Howard N J, Silink M
Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Camperdown, NSW, Australia.
Diabet Med. 1996 Jan;13(1):65-71. doi: 10.1002/(SICI)1096-9136(199601)13:1<65::AID-DIA997>3.0.CO;2-W.
Autonomic and peripheral nerve function were studied prospectively in 102 adolescents with Type 1 diabetes over a 5-year period. All adolescents were assessed three times; 54 were assessed four times. The median age at baseline was 14.5 (range 10.4-18.0) yr. The median diabetes duration at baseline was 6.8 (range 1.3-15.2) yr. Autonomic nerve function was assessed by measuring heart rate variation during deep breathing, valsalva manoeuvre, standing from a lying position (30/15 ratio), and the postural change in systolic blood pressure. Peripheral nerve function was assessed by determining the thermal threshold for heat and cold at the wrist and foot and the vibration threshold at the great toe and medial malleolus. At baseline, 29.5% adolescents had at least one abnormal autonomic nerve test and 28.4% had at least one abnormal peripheral nerve test. There was no significant increase in the number of abnormalities over the study period. Persisting abnormalities were present in only six individuals. Abnormalities were not related to age, diabetes duration or glycaemic control. In summary, a low rate of neurological abnormalities was found, suggesting that more than 3 years of follow-up is required to detect evolving neuropathy in this age group.
对102名1型糖尿病青少年进行了为期5年的自主神经和周围神经功能前瞻性研究。所有青少年均接受了三次评估；54人接受了四次评估。基线时的中位年龄为14.5岁（范围10.4 - 18.0岁）。基线时糖尿病的中位病程为6.8年（范围1.3 - 15.2年）。通过测量深呼吸、瓦尔萨尔瓦动作、从卧位站立（30/15比值）期间的心率变化以及收缩压的体位变化来评估自主神经功能。通过测定手腕和足部的热觉和冷觉阈值以及大脚趾和内踝的振动觉阈值来评估周围神经功能。在基线时，29.5%的青少年至少有一项自主神经测试异常，28.4%的青少年至少有一项周围神经测试异常。在研究期间，异常数量没有显著增加。只有6个人存在持续异常。异常与年龄、糖尿病病程或血糖控制无关。总之，发现神经异常发生率较低，这表明该年龄组需要超过3年的随访才能检测到进展性神经病变。
