Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications.
Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications.
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DOI：
10.4239/wjd.v12.i6.855
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发表时间：
2021-06-15
影响因子：
4.2
通讯作者：
Rodrigues LF Jr
中科院分区：
文献类型：
--
作者：
Duque A;Mediano MFF;De Lorenzo A;Rodrigues LF Jr
心血管自主神经病变（CAN）是一种使人衰弱的疾病，主要发生在长期存在的2型糖尿病患者中，但可以更早出现，甚至在糖尿病确诊之前。CAN是一种微血管并发症，由支配心脏和血管的交感神经和副交感神经纤维病变引起，并促进心血管自主控制的改变。整个机制尚不清楚，但CAN的病理生理的几个方面已经被描述，如晚期糖基化终产物的产生、活性氧、核因子κ B和促炎细胞因子。这种微血管并发症是无症状心肌缺血、慢性肾脏疾病、心肌功能障碍、主要心血管事件、心律失常和猝死的重要危险因素。也有研究表明，与其他传统的心血管危险因素相比，CAN的进展可能对心血管疾病的发展有更大的影响。然而，CAN可能在数年内处于亚临床状态，晚期诊断会增加死亡风险。从亚临床阶段到临床阶段的过渡期持续时间尚不清楚，但CAN的进展与预后不良有关。几种测试可用于can的诊断，如心率变异性（HRV）、心血管自主反射测试和心肌闪烁成像。目前，已经有研究表明，即使在亚临床阶段，通过降低HRV也可以检测到CAN，这是一种无创检测，操作成本较低。因此，考虑到糖尿病是一种全球性的流行病，糖尿病性神经病变是糖尿病最常见的慢性并发症，早期发现和治疗CAN可能是降低与这种长期疾病相关的发病率和死亡率的关键。
Cardiovascular autonomic neuropathy (CAN) is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier, even before diabetes is diagnosed. CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers, which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control. The entire mechanism is still not elucidated, but several aspects of the pathophysiology of CAN have already been described, such as the production of advanced glycation end products, reactive oxygen species, nuclear factor kappa B, and pro-inflammatory cytokines. This microvascular complication is an important risk factor for silent myocardial ischemia, chronic kidney disease, myocardial dysfunction, major cardiovascular events, cardiac arrhythmias, and sudden death. It has also been suggested that, compared to other traditional cardiovascular risk factors, CAN progression may have a greater impact on cardiovascular disease development. However, CAN might be subclinical for several years, and a late diagnosis increases the mortality risk. The duration of the transition period from the subclinical to clinical stage remains unknown, but the progression of CAN is associated with a poor prognosis. Several tests can be used for CAN diagnosis, such as heart rate variability (HRV), cardiovascular autonomic reflex tests, and myocardial scintigraphy. Currently, it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV, which is a non-invasive test with a lower operating cost. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.
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DOI：
10.2147/dmso.s129797
发表时间：
2017
期刊：
Diabetes, metabolic syndrome and obesity : targets and therapy
影响因子：
--
作者：
Fisher VL;Tahrani AA
通讯作者：
Tahrani AA
影响因子：
3.5
作者：
Kempler, P;Tesfaye, S;Fuller, JH
通讯作者：
Fuller, JH
影响因子：
--
作者：
Agashe, Shruti;Petak, Steven
通讯作者：
Petak, Steven
影响因子：
16.2
作者：
Astrup, AS;Tarnow, U;Parving, HH
通讯作者：
Parving, HH
影响因子：
4
作者：
Billman GE
通讯作者：
Billman GE