Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus
Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus
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DOI：
10.1161/01.cir.100.8.813
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发表时间：
1999-08-24
期刊：
影响因子：
37.8
通讯作者：
Grunberger, G
中科院分区：
文献类型：
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作者：
Di Carli, M;Bianco-Batlles, D;Grunberger, G
心脏交感神经信号在心肌灌注的调节中起着重要的作用。我们假设交感神经介导的心肌血流量将受损糖尿病自主神经neuropathics.Methods和Results-We研究了28例糖尿病患者（43+/-7岁）和11名年龄匹配的健康志愿者。PET用于描绘心脏交感神经支配与[C-11]羟麻黄碱（[C-11]HED）和测量心肌血流量在休息，充血期间，并在交感神经刺激冷加压试验。还评价了对心脏自主神经反射试验的反应。使用超声检查，我们还测量了反应性充血（内皮依赖性舒张）和舌下含服硝酸甘油（内皮非依赖性舒张）后的肱动脉反应性。基于[C-11]HED PET，28名糖尿病患者中有13名患有交感神经功能障碍（SND）。糖尿病患者和正常受试者的基础血流区域均匀且相似。在充血期间，正常受试者的血流量增加（284+/-88%）大于有SND的糖尿病患者（187+/-80%，P=0.084）和无SND的糖尿病患者（177+/-72%，P=0.028）。然而，SND糖尿病患者（14+/-10%）对冷反应的血流增加低于无SND糖尿病患者（31+/-12%）（P=0.015）和正常人（48+/-24%）（P
Background-Cardiac sympathetic signals play an important role in the regulation of myocardial perfusion. We hypothesized that sympathetically mediated myocardial blood flow would be impaired in diabetics with autonomic neuropathy.Methods ana Results-We studied 28 diabetics (43+/-7 years old) and 11 age-matched healthy volunteers. PET was used to delineate cardiac sympathetic innervation with [C-11]hydroxyephedrine ([C-11]HED) and to measure myocardial blood flow at rest, during hyperemia, and in response to sympathetic stimulation by cold pressor testing. The response to cardiac autonomic reflex tests was also evaluated. Using ultrasonography, we also measured brachial artery reactivity during reactive hyperemia (endothelium-dependent dilation) and after sublingual nitroglycerin (endothelium-independent dilation). Based on [C-11]HED PET, 13 of 28 diabetics had sympathetic-nerve dysfunction (SND). Basal flow was regionally homogeneous and similar in the diabetic and normal subjects. During hyperemia, the increase in flow was greater in the normal subjects (284+/-88%) than in the diabetics with SND (187+/-80%, P=0.084) and without SND (177+/-72%, P=0.028). However, the increase in flow in response to cold was lower in the diabetics with SND (14+/-10%) than in those without SND (31+/-12%) (P=0.015) and the normal subjects (48+/-24%) (P