Painful diabetic neuropathy is associated with greater autonomic dysfunction than painless diabetic neuropathy.
Painful diabetic neuropathy is associated with greater autonomic dysfunction than painless diabetic neuropathy.
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DOI：
10.2337/dc09-2314
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发表时间：
2010-07
期刊：
影响因子：
16.2
通讯作者：
Tesfaye S
中科院分区：
文献类型：
--
作者：
Gandhi RA;Marques JL;Selvarajah D;Emery CJ;Tesfaye S
尽管人们认识到糖尿病周围神经病变（DPN）和自主神经病变之间存在明确的联系，但自主神经病变与DPN亚型的关系尚不清楚。本研究旨在探讨自主神经病变与无痛性和痛性DPN的关系。80名受试者（20名健康志愿者，20名无DPN，20名疼痛性DPN，20名无痛性DPN）接受了详细的神经生理学检查（包括常规自主神经功能测试[AFT]）和短期心率变异性（HRV）的频谱分析，以评估心率的交感迷走神经调制。评估了各种频域（包括低频[LF]、高频[HF]和总功率[TP]）和时域（所有正常至正常R-R间期的标准差[SDNN]和连续差异的均方根[RMSSD]）参数。HRV分析显示各组间LF、HF、TP、SDNN和RMSSD有显著差异（ANOVA P < 0.001）。亚组分析显示，与无痛DPN相比，疼痛DPN的HF（3.59 ± 1.08 [均值±标准差] vs. 2.67 ± 1.56）、TP（5.73 ± 1.28 vs. 4.79 ± 1.51）和SDNN（2.91 ± 0.65 vs. 1.62 ± 3.5）显著降低，P < 0.05。无痛性DPN和疼痛性DPN之间使用AFT没有显著差异。这项研究表明，疼痛性DPN比无痛性DPN与更大的自主神经功能障碍相关。这些变化只能通过HRV的频谱分析（一种基于5分钟心电图记录的简单测试）来检测，这表明它是检测自主神经功能障碍的更敏感的工具，而糖尿病患者的自主神经功能障碍仍然没有被检测到。在疼痛性DPN中观察到的更大的自主神经功能障碍可能反映了更主要的小纤维参与，并增加了其在疼痛性DPN病理生理学中作用的越来越多的证据。
Although a clear link between diabetic peripheral neuropathy (DPN) and autonomic neuropathy is recognized, the relationship of autonomic neuropathy with subtypes of DPN is less clear. This study aimed to investigate the relationship of autonomic neuropathy with painless and painful DPN. Eighty subjects (20 healthy volunteers, 20 with no DPN, 20 with painful DPN, 20 with painless DPN) underwent detailed neurophysiological investigations (including conventional autonomic function tests [AFTs]) and spectral analysis of short-term heart rate variability (HRV), which assesses sympathovagal modulation of the heart rate. Various frequency-domain (including low frequency [LF], high frequency [HF], and total power [TP]) and time-domain (standard deviation of all normal-to-normal R-R intervals [SDNN] and root mean square of successive differences [RMSSD]) parameters were assessed. HRV analysis revealed significant differences across the groups in LF, HF, TP, SDNN, and RMSSD (ANOVA P < 0.001). Subgroup analysis showed that compared with painless DPN, painful DPN had significantly lower HF (3.59 ± 1.08 [means ± SD] vs. 2.67 ± 1.56), TP (5.73 ± 1.28 vs. 4.79 ± 1.51), and SDNN (2.91 ± 0.65 vs. 1.62 ± 3.5), P < 0.05. No significant differences were seen between painless DPN and painful DPN using an AFT. This study shows that painful DPN is associated with significantly greater autonomic dysfunction than painless DPN. These changes are only detected using spectral analysis of HRV (a simple test based on a 5-min electrocardiogram recording), suggesting that it is a more sensitive tool to detect autonomic dysfunction, which is still under-detected in people with diabetes. The greater autonomic dysfunction seen in painful DPN may reflect more predominant small fiber involvement and adds to the growing evidence of its role in the pathophysiology of painful DPN.
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影响因子：
37.8
作者：
MONTANO, N;RUSCONE, TG;MALLIANI, A
通讯作者：
MALLIANI, A
影响因子：
158.5
作者：
Boulton, AJM;Kirsner, RS;Vileikyte, L
通讯作者：
Vileikyte, L
影响因子：
8.2
作者：
Eaton, SEM;Harris, ND;Tesfaye, S
通讯作者：
Tesfaye, S
影响因子：
9.9
作者：
DYCK, PJ;ZIMMERMAN, I;OBRIEN, PC
通讯作者：
OBRIEN, PC
影响因子：
3.4
作者：
Dyck, PJ;Litchy, WJ;O'Brien, PC
通讯作者：
O'Brien, PC