Frattola A, Parati G, Gamba P, Paleari F, Mauri G, Di Rienzo M, Castiglioni P, Mancia G
Istituto Scientifico Ospedale S. Luca, Milano, Italy.
Diabetologia. 1997 Dec;40(12):1470-5. doi: 10.1007/s001250050851.
Diabetic autonomic dysfunction is associated with a high risk of mortality which makes its early identification clinically important. The aim of our study was to compare the detection of autonomic dysfunction provided by classical laboratory autonomic function tests with that obtained through computer assessment of the spontaneous sensitivity of the baroreceptor-heart rate reflex (BRS) by time domain and frequency domain techniques. In 20 normotensive diabetic patients (mean age +/- SD 41.9 +/- 8.1 years) with no evidence of autonomic dysfunction on laboratory autonomic testing (D0) blood pressure (BP) and ECG were continuously monitored over 15 min in the supine position. BRS was assessed as the slope of the regression line between spontaneous increases or reductions in systolic BP and linearly related lengthening or shortening in RR interval over sequences of at least 4 consecutive beats (sequence method), or as the squared ratio between RR interval and systolic BP spectral powers around 0.1 Hz. We compared the results with those of 32 age-matched normotensive diabetic patients with abnormal autonomic function tests (D1) and with those of 24 healthy age-matched control subjects with normal autonomic function tests (C). Compared to C, BRS was markedly less in D1 when assessed by both the slope of the two types of sequences (data pooled) and by the spectral method (-71.3% and -60.2% respectively, both p < 0.01). However, BRS was consistently although somewhat less markedly reduced in D0, the reduction being clearly evident for all the estimates (-57.0% and -43.5%, both p < 0.01). The effects were more evident than those obtained by the simple quantification of the RR interval variability. These data suggest that time and frequency domain estimates of spontaneous BRS allow earlier detection of diabetic autonomic dysfunction than classical laboratory autonomic tests. The estimates can be obtained by short non-invasive recording of the BP and RR interval signals in the supine patient, i.e. under conditions suitable for routine outpatient evaluation.
糖尿病自主神经功能障碍与高死亡率相关，这使得其早期识别具有重要的临床意义。我们研究的目的是比较经典实验室自主神经功能测试与通过时域和频域技术对压力感受器 - 心率反射（BRS）的自发敏感性进行计算机评估所提供的自主神经功能障碍检测结果。在20名血压正常的糖尿病患者（平均年龄±标准差41.9±8.1岁）中，实验室自主神经测试（D0）未显示自主神经功能障碍迹象，在仰卧位连续监测15分钟的血压（BP）和心电图。BRS被评估为至少4个连续心动周期序列中收缩压的自发升高或降低与RR间期线性相关的延长或缩短之间回归线的斜率（序列法），或作为RR间期与0.1Hz左右收缩压频谱功率的平方比。我们将结果与32名年龄匹配、自主神经功能测试异常的血压正常糖尿病患者（D1）以及24名年龄匹配、自主神经功能测试正常的健康对照者（C）的结果进行了比较。与C组相比，通过两种序列斜率（合并数据）和频谱法评估时，D1组的BRS明显降低（分别为-71.3%和-60.2%，均p<0.01）。然而，D0组的BRS也持续降低，尽管降低程度稍小，所有估计值均明显降低（分别为-57.0%和-43.5%，均p<0.01）。这些影响比通过简单量化RR间期变异性所获得的影响更明显。这些数据表明，与经典实验室自主神经测试相比，自发BRS的时域和频域估计能够更早地检测出糖尿病自主神经功能障碍。这些估计可以通过在仰卧位患者中短时间无创记录BP和RR间期信号获得，即在适合常规门诊评估的条件下获得。
