SENSITIVITY OF R-R VARIATION AND VALSALVA RATIO IN ASSESSMENT OF CARDIOVASCULAR DIABETIC AUTONOMIC NEUROPATHY
SENSITIVITY OF R-R VARIATION AND VALSALVA RATIO IN ASSESSMENT OF CARDIOVASCULAR DIABETIC AUTONOMIC NEUROPATHY
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DOI：
10.2337/diacare.10.6.735
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发表时间：
1987-11-01
期刊：
影响因子：
16.2
通讯作者：
PFEIFER, MA
中科院分区：
文献类型：
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作者：
ROTHSCHILD, AH;WEINBERG, CR;PFEIFER, MA
R-R变异和Valsalva比值通常用于定量评估糖尿病自主神经病变（DAN）。为了评估这两种方法对副交感神经消融的敏感性，12名非糖尿病受试者在分级剂量（0.3-4.0 mg静脉注射）阿托品前后进行了测试。R-R变异在0.7 mg时显著减小，而Valsalva比值直到2.0 mg剂量的阿托品才显著减小。在0.85、1.0和2.0 mg剂量期间，R-R变异继续逐渐变小。4.0 mg剂量进一步降低了缬沙瓦比值，但没有R-R变化。为了进一步比较这两种测量方法，将两组糖尿病受试者与一组非糖尿病受试者进行比较（n = 22）。其中一组有DAN症状（n = 22），另一组无DAN症状（n = 19）。在DAN受试者中，R-R变异(非糖尿病患者为33.2 .+-。4.3 vs. DAN 9.8。1.2, P < 0.001)和Valsalva比值(非糖尿病患者1.98。0.07 vs. DAN 1.55。0.07, P < 0.001)。然而，在无症状的受试者中，R-R变异(23.2 .+-。3.9, P < 0.05)，而Valsalva比值为1.94。0.13， NS)，低于非糖尿病受试者。即使在。beta之后。两组糖尿病患者的R-R变异仍然较小(非糖尿病患者为34.4 .+-。4.2 vs. DAN 7.4 .+-。1.3, p < 0.001；无症状21.8 .+。3.3, p < 0.02)。因此，R-R变异的减少更可能是由于副交感神经活动的减少而不是交感神经活动的增加。我们认为R-R变异在检测副交感神经消融方面比Valsalva比值更敏感，可用于轻度自主神经功能障碍的早期发现和随访。Valsalva比值对于严重糖尿病自主神经功能障碍患者的连续长期评估可能更有用，在这些患者中R-R变异受到最大程度的抑制。
R-R variation and the Valsalva ratio are commonly used to quantitatively assess diabetic autonomic neuropathy (DAN). To assess the sensitivity of these two measures to parasympathetic ablation, 12 nondiabetic subjects were tested before and after graded doses (0.3-4.0 mg i.v.) of atropine. R-R variation was significantly reduced at 0.7 mg, whereas Valsalva ratio was not significantly smaller until the 2.0-mg dose of atropine. R-R variation continued to become progressively smaller during the 0.85-, 1.0-, and 2.0-mg doses. Valsalva ratio, but not R-R variation, was further reduced by the 4.0-mg dose. To further compare these two measures, two groups of diabetic subjects were compared with a group of nondiabetic subjects (n = 22). One group of diabetic subjects had symptoms of DAN (n = 22), and the other diabetic group had no symptoms of DAN (n = 19). In DAN subjects, both R-R variation (nondiabetic 33.2 .+-. 4.3 vs. DAN 9.8 .+-. 1.2, P < 0.001) and the Valsalva ratio (nondiabetic 1.98 .+-. 0.07 vs. DAN 1.55 .+-. 0.07, P < 0.001) were reduced. However, in asymptomatic subjects, R-R variation (23.2 .+-. 3.9, P < 0.05), but not Valsalva ratio (1.94 .+-. 0.13, NS), was less than nondiabetic subjects. Even after .beta.-blockade, R-R variation was still less in both groups of diabetic subjects (nondiabetic 34.4 .+-. 4.2 vs. DAN 7.4 .+-. 1.3, P < 0.001; asymptomatic 21.8 .+-. 3.3, P < 0.02). Thus, the reduced R-R variation is more likely due to decreased parasympathetic rather than increased sympathetic activity. We conclude that R-R variation is more sensitive than Valsalva ratio in detecting parasympathetic ablation and is useful for early detection and follow-up of mild autonomic dysfunction. Valsalva ratio may be more useful for sequential long-term evaluation in subjects with severe diabetic autonomic dysfunction, in whom R-R variation is maximally suppressed.