Spallone V, Maiello M R, Cicconetti E, Menzinger G
Department of Internal Medicine, Tor Vergata University, Complesso Integrato Columbus, Rome, Italy.
Diabetes Res Clin Pract. 1997 Jan;34(3):169-79. doi: 10.1016/s0168-8227(96)01354-x.
In 97 IDDM and 64 NIDDM patients aged under 65 years, we evaluated the relationship between autonomic neuropathy (AN) and retinopathy, nephropathy, glycemic control and cardiovascular risk factors. Diabetes duration and HbA1 were significantly higher and body mass index was significantly lower in IDDM patients with AN compared to those without. In NIDDM only age was significantly higher in neuropathic patients. AN was associated with retinopathy in both IDDM (chi2 = 10, P < 0.03) and NIDDM patients (chi2 = 14, P < 0.007), while only in IDDM albumin excretion was significantly higher in patients with AN. Blood pressure (BP) was significantly higher in both IDDM and NIDDM patients with AN compared to those without. There were no differences in smoking and serum lipids between patients with and those without AN. We performed a multiple regression analysis using autonomic score, index of cardiovascular tests impairment, as the dependent variable and age, diabetes duration, body mass index, HbA1, albumin excretion, cholesterolemia, triglyceridemia, systolic BP, and retinopathy as independent variables. With this model in IDDM autonomic score was only related to body mass index (r = -0.29, P < 0.05), to HbA1 (r = 0.46, P < 0.001), and to systolic BP (r = 0.24, P < 0.05), while in NIDDM it was only related to systolic BP (r = 0.54, P < 0.001). In conclusion, AN was related to age in NIDDM, and to diabetes duration and glycemic control in IDDM. AN was associated with retinopathy, with nephropathy (only in IDDM), and with BP levels, but not with dyslipidemia, smoking, or obesity. Excess mortality rate observed in diabetic AN cannot be referred to an association with cardiovascular risk factors.
在97例年龄小于65岁的胰岛素依赖型糖尿病（IDDM）患者和64例非胰岛素依赖型糖尿病（NIDDM）患者中，我们评估了自主神经病变（AN）与视网膜病变、肾病、血糖控制及心血管危险因素之间的关系。与无AN的IDDM患者相比，有AN的患者糖尿病病程和糖化血红蛋白（HbA1）显著更高，而体重指数显著更低。在NIDDM患者中，仅神经病变患者的年龄显著更高。在IDDM（χ² = 10，P < 0.03）和NIDDM患者（χ² = 14，P < 0.007）中，AN均与视网膜病变相关，而仅在IDDM中，有AN的患者白蛋白排泄显著更高。与无AN的患者相比，有AN的IDDM和NIDDM患者血压（BP）均显著更高。有AN和无AN的患者在吸烟和血脂方面无差异。我们以自主神经评分（心血管测试损害指数）作为因变量，以年龄、糖尿病病程、体重指数、HbA1、白蛋白排泄、胆固醇血症、甘油三酯血症、收缩压及视网膜病变作为自变量进行了多元回归分析。在这个模型中，IDDM患者的自主神经评分仅与体重指数（r = -0.29，P < 0.05）、HbA1（r = 0.46，P < 0.001）及收缩压（r = 0.24，P < 0.05）相关，而在NIDDM中仅与收缩压相关（r = 0.54，P < 0.001）。总之，在NIDDM中AN与年龄相关，在IDDM中与糖尿病病程及血糖控制相关。AN与视网膜病变、肾病（仅在IDDM中）及血压水平相关，但与血脂异常、吸烟或肥胖无关。糖尿病AN患者中观察到的过高死亡率不能归因于与心血管危险因素的关联。
