Mustonen J, Uusitupa M, Mäntysaari M, Länsimies E, Pyörälä K, Laakso M
Department of Medicine, Kuopio University Hospital, Finland.
J Intern Med. 1997 Mar;241(3):227-35. doi: 10.1046/j.1365-2796.1997.116126000.x.
To study the changes in autonomic nervous function during the 4-year follow-up period in diabetic patients and to investigate factors predicting autonomic nervous dysfunction.
A 4-year follow-up study.
At baseline the study subjects without known cardiovascular disease were recruited from a large group of diabetic and nondiabetic subjects selected randomly from a baseline population.
Middle-aged control subjects (n = 44), patients with insulin-dependent diabetes mellitus (n = 32) and patients with non-insulin-dependent diabetes mellitus (n = 32) were studied at baseline and after the 4-year follow-up.
Autonomic nervous function tests and exercise test at baseline and after the 4-year follow-up.
At the baseline, heart rate variation during deep breathing was significantly lower in patients with insulin-dependent diabetes (13.0 +/- 1.2 beats min-1; P < 0.05) and in patients with non-insulin-dependent diabetes (12.9 +/- 1.5 beats min-1; P < 0.05) than in control subjects (16.6 +/- 1.1 beats min-1). At baseline, autonomic nervous function score was significantly higher indicating disturbed autonomic nervous function in patients with insulin-dependent diabetes (1.74 +/- 0.19; P < 0.01) than in control subjects (1.24 +/- 0.14), but the difference was not significant between control subjects and patients with non-insulin-dependent diabetes (1.47 +/- 0.12). During the follow-up, autonomic nervous function score increased in patients with non-insulin-dependent diabetes to 2.00 +/- 0.21 (P < 0.001, as compared to baseline), but did not change in patients with insulin-dependent diabetes (1.77 +/- 0.18) or control subjects (1.22 +/- 0.12). In both diabetic groups, the deterioration of autonomic nervous function score during the 4-year follow-up was associated with poor glycaemic control at baseline. Clinical manifestation of coronary heart disease was found in three (7%) control subjects, 12 (37%; P < 0.001) patients with insulin-dependent diabetes and 11 (34%; P < 0.01) patients with non-insulin-dependent diabetes mellitus at follow-up examination. Autonomic nervous function was more abnormal in those insulin-dependent diabetic patients with coronary heart disease than those without.
During the 4-year follow-up the impairment in autonomic nervous function occurred mainly in patients with noninsulin-dependent diabetes. Poor glycaemic control appears to be an important determinant of the progression of autonomic nervous dysfunction in diabetes.
研究糖尿病患者在4年随访期间自主神经功能的变化，并探讨预测自主神经功能障碍的因素。
一项4年随访研究。
在基线时，研究对象从一大群从基线人群中随机选取的糖尿病和非糖尿病受试者中招募，这些受试者无已知心血管疾病。
中年对照受试者（n = 44）、胰岛素依赖型糖尿病患者（n = 32）和非胰岛素依赖型糖尿病患者（n = 32）在基线时及4年随访后接受研究。
在基线时及4年随访后进行自主神经功能测试和运动试验。
在基线时，胰岛素依赖型糖尿病患者（13.0±1.2次/分钟；P<0.05）和非胰岛素依赖型糖尿病患者（12.9±1.5次/分钟；P<0.05）深呼吸时的心率变异性显著低于对照受试者（16.6±1.1次/分钟）。在基线时，胰岛素依赖型糖尿病患者（1.74±0.19；P<0.01）的自主神经功能评分显著高于对照受试者（1.24±0.14），表明自主神经功能紊乱，但对照受试者与非胰岛素依赖型糖尿病患者（1.47±0.12）之间的差异不显著。在随访期间，非胰岛素依赖型糖尿病患者的自主神经功能评分增加至2.00±0.21（与基线相比，P<0.001），但胰岛素依赖型糖尿病患者（1.77±0.18）或对照受试者（1.22±0.12）的评分未发生变化。在两个糖尿病组中，4年随访期间自主神经功能评分的恶化与基线时血糖控制不佳有关。在随访检查中，3名（7%）对照受试者、12名（37%；P<0.001）胰岛素依赖型糖尿病患者和11名（34%；P<0.01）非胰岛素依赖型糖尿病患者出现冠心病临床表现。患有冠心病的胰岛素依赖型糖尿病患者的自主神经功能比未患冠心病的患者更异常。
在4年随访期间，自主神经功能损害主要发生在非胰岛素依赖型糖尿病患者中。血糖控制不佳似乎是糖尿病自主神经功能障碍进展的一个重要决定因素。
