Impaired Cardiovascular Responses to Graded Exercise in Diabetic Autonomic Neuropathy
Impaired Cardiovascular Responses to Graded Exercise in Diabetic Autonomic Neuropathy
复制标题
糖尿病自主神经病变患者对分级运动的心血管反应受损
作者：
J. Hilsted;H. Galbo;N. Christensen
6名有自主神经病变体征（深呼吸时心率的逐搏变化减少）的青少年糖尿病患者[年龄，31 ± 2岁（平均值和标准差）;糖尿病病程，15 ± 4年]和7名年龄（27 ± 1岁）和糖尿病病程（14 ± 2年）相似的对照组患者在一个测力计周期内进行分级运动。与对照组患者相比，自主神经病变患者静息心率较高，最低工作负荷（50 W）时心率的增加减少（P < 0.001），表明迷走神经缺陷。自主神经病变之间的关系，心率和收缩压，分别和相对工作负荷（表示为氧摄取量-在一个人的最大氧摄取量）与以前的研究结果在正常受试者在β-肾上腺素能受体阻滞剂，表明受损的交感神经活动。自主神经病变组的最大心率为157 ± 9 min-1，对照组为181 ± 4 min-1，P < 0.05;最大收缩压分别为179 ± 11 mm Hg和197 ± 5 mm Hg。自主神经病变组最大耐受工作量明显低于对照组（125 ± 13 vs 161 ± 9 w，P < 0.05）。同样，最大摄氧量降低（1.68 ± 0.21 vs. 2.78 ± 0.18 L/min，25 ± 3 vs. 38 ± 2 ml/min/kg，P < 0.005）。总之，糖尿病患者的心跳到心跳的变化减少显示的迹象，心血管功能障碍的副交感神经，以及交感神经的起源在分级运动。
Six juvenile diabetics [age, 31 ± 2 yr (mean and SEM); duration of diabetes, 15 ± 4 yr] with signs of autonomic neuropathy (decreased beat-to-beat variation in heart rate during deep breathing) and seven control patients of similar age (27 ± 1 yr) and duration of diabetes (14 ± 2 yr) performed graded exercise oh an ergometer cycle. Resting heart rate was higher and the increase in heart rate at the lowest work load (50 W) was diminished in patients with autonomic neuropathy compared with control patients (P < 0.001), indicating a vagal defect. The relationships in autonomic neuropathy between heart rate and systolic blood pressure, respectively, and relative work load (expressed as oxygen uptake — in percent—of individual maximal oxygen uptake) were identical with previous findings in normal subjects during beta-adrenergic receptor blockade, indicating impaired sympathetic activity. Maximal heart rate was 157 ± 9 min−1 in autonomic neuropathy and 181 ± 4 in controls, P < 0.05; maximal systolic blood pressure was 179 ± 11 mm Hg and 197 ± 5, respectively. The greatest tolerable work load was significantly less in patients with autonomic neuropathy (125 ± 13 vs. 161 ± 9 w, P < 0.05). Similarly, maximal oxygen uptake was reduced (1.68 ± 0.21 vs. 2.78 ± 0.18 L/min, 25 ± 3 vs. 38 ± 2 ml/min/kg, P < 0.005). In conclusion, diabetics with decreased beat-to-beat variation in heart rate displayed signs of cardiovascular dysfunction of parasympathetic as well as sympathetic origin during graded exercise.