Matsuto T, Inano K, Miida T, Okada M
Department of Laboratory Medicine, Niigata University School of Medicine.
Rinsho Byori. 1998 Oct;46(10):1037-42.
Neuropathy is a frequent complication in diabetes mellitus. Since the involvement of the autonomic nervous system indicates a poor prognosis, early detection and subsequent management are important. Analysis of heart rate variability (HRV) provides a quantitative measure of sympathovagal modulation activities on the heart and has been proven to be useful for the early assessment of the diabetic autonomic neuropathy. We recently developed a simple method of measuring pulse wave velocity (PWV) to evaluate sympathetic nervous activity in the vascular system. In this paper, we examined 33 diabetic patients with and without peripheral neuropathy (15 and 18 respectively) using these methods. In time domain analysis, the mean heart rate, standard deviation and coefficient of variation of HRVs significantly differed between these two groups, whereas the indices of PWVs did not show a significant difference. In frequency domain analysis of HRV, both low and high frequency components were decreased, and the low frequency component in normalized unit did not increase after standing in patients with peripheral neuropathy. We previously reported that the mean PWV decreased after standing in patients with diabetic neuropathy. This disagreement suggests that beta sympathetic dysfunction precedes alpha sympathetic dysfunction in diabetic neuropathy.
神经病变是糖尿病常见的并发症。由于自主神经系统受累提示预后不良，因此早期检测及后续处理至关重要。心率变异性（HRV）分析可定量评估心脏的交感迷走神经调节活动，已被证明有助于糖尿病自主神经病变的早期评估。我们最近开发了一种简单的测量脉搏波速度（PWV）的方法，以评估血管系统中的交感神经活动。在本文中，我们使用这些方法对33例糖尿病患者进行了检查，其中15例有外周神经病变，18例无外周神经病变。在时域分析中，这两组患者的平均心率、HRV的标准差和变异系数有显著差异，而PWV指标未显示出显著差异。在HRV的频域分析中，低频和高频成分均降低，外周神经病变患者站立后归一化单位的低频成分未增加。我们之前报道过，糖尿病神经病变患者站立后平均PWV降低。这种差异表明，在糖尿病神经病变中，β交感神经功能障碍先于α交感神经功能障碍出现。
