Rutter M K, McComb J M, Brady S, Marshall S M
Department of Medicine, University of Newcastle upon Tyne, UK.
Clin Auton Res. 1998 Oct;8(5):251-7. doi: 10.1007/BF02277970.
Patients with non-insulin-dependent diabetes mellitus (NIDDM) and microalbuminuria (MA) are at increased risk of early death. In NIDDM patients without evidence of heart disease, we examined the links between MA and autonomic neuropathy (AN) and reduced heart rate variability (HRV), both of which have been linked to a poor prognosis. We have studied 43 asymptomatic NIDDM patients with MA and have matched them with 43 normoalbuminuric patients for age, gender, diabetes duration, and smoking status. AN was assessed by heart rate changes to deep breathing, Valsalva, and posture and blood pressure changes to posture and hand grip. Twenty-four hour Holter monitoring was used to evaluate HRV. Patients with MA showed evidence of AN and reduced HRV when compared with normoalbuminuric patients. In multivariate analysis, with measures of AN and HRV as outcome variables, Log albumin excretion rate was a significant independent predictor but stronger predictors were the presence of diabetic retinopathy, age, body mass index, claudication, alcohol consumption, and calcium channel blocker use. The presence of MA is linked to AN and reduced HRV in asymptomatic NIDDM patients. The nature of the relationship is complex, involving multiple relationships with other clinical parameters.
非胰岛素依赖型糖尿病（NIDDM）合并微量白蛋白尿（MA）的患者早死风险增加。在无心脏病证据的NIDDM患者中，我们研究了MA与自主神经病变（AN）以及心率变异性（HRV）降低之间的联系，二者均与预后不良有关。我们研究了43例无症状的NIDDM合并MA患者，并将他们与43例尿白蛋白正常的患者按年龄、性别、糖尿病病程和吸烟状况进行匹配。通过深呼吸、瓦尔萨尔瓦动作和体位改变时的心率变化以及体位和握力改变时的血压变化来评估AN。采用24小时动态心电图监测来评估HRV。与尿白蛋白正常的患者相比，MA患者存在AN且HRV降低。在多变量分析中，以AN和HRV测量值作为结果变量，对数白蛋白排泄率是一个显著的独立预测因素，但更强的预测因素是糖尿病视网膜病变的存在、年龄、体重指数、间歇性跛行、饮酒和使用钙通道阻滞剂。在无症状的NIDDM患者中，MA的存在与AN及HRV降低有关。这种关系的性质很复杂，涉及与其他临床参数的多种关联。
