Progression of diabetic autonomic neuropathy over a decade in insulin-dependent diabetics.
Progression of diabetic autonomic neuropathy over a decade in insulin-dependent diabetics.
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胰岛素依赖型糖尿病患者十多年来糖尿病自主神经病变的进展。
DOI：
10.1093/oxfordjournals.qjmed.a068470
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
P. Watkins
中科院分区：
文献类型：
--
作者：
M. Sampson;S. Wilson;P. Karagiannis;M. Edmonds;P. Watkins
有自主神经病变的糖尿病患者的预后鲜为人知。因此，我们研究了年轻的胰岛素依赖型糖尿病患者的进展，这些患者在10-15年前首次被确认为自主神经功能异常。我们已经证明，有症状自主神经病变的糖尿病患者的死亡率增加，但低于先前报道的水平。自主神经功能测试有孤立异常的无症状糖尿病患者的死亡率不会增加。在心率变异性最初正常的糖尿病患者中，心率变异性每年下降1.02+/-0.47(SD)。虽然自主神经病变的症状通常不会在十年后缓解，但它们通常不会进展。三组年轻的胰岛素依赖型糖尿病患者在1972至1977年间接受了心率变异性测试，并在10-15年后进行了审查。A组(n=49)有症状自主神经病变且心率变异性异常(<12)，B组(n=24)无症状但心率变异性异常(n=24)，C组(n=38)无症状但心率变异性正常(16~26)。A组10年生存率(73.4%)低于B组(91.7%)和C组(89.5%)，P<0.05。A组死亡原因主要为肾功能衰竭(n=4)、肾病患者心肌梗死(n=3)和猝死(n=3)。自主神经病变的主要症状--腹泻、体位性低血压和味觉出汗--非常持久，但在大多数患者中并不一定恶化或致残。在无症状的心率变异性异常的患者中，自主神经症状的发展在过去十年中是罕见的。
The prognosis for diabetics with autonomic neuropathy is little known. We therefore studied the progress of young insulin-dependent diabetics, first identified as having abnormal autonomic function 10-15 years ago. We have shown that the mortality of diabetics with symptomatic autonomic neuropathy is increased, but is less than previously reported. Mortality in asymptomatic diabetics with an isolated abnormality in autonomic function tests is not increased. The heart rate variability declines at 1.02 +/- 0.47 (SD) per annum in diabetics with an initially normal heart rate variability. While symptoms of autonomic neuropathy do not usually remit even over a decade, they do not commonly progress. Three groups of young insulin-dependent diabetics had heart rate variability tested between 1972 and 1977 and have been reviewed 10-15 years later. Group A (n = 49) had symptomatic autonomic neuropathy and an abnormal heart rate variability (less than 12), Group B (n = 24) were asymptomatic yet had an abnormal heart rate variability and Group C (n = 38) were asymptomatic and had a normal heart rate variability (16-26). The 10-year survival in Group A (73.4 per cent) was less (P less than 0.05) than in Groups B (91.7 per cent) or C (89.5 per cent) which did not differ from each other. The 18 Group A deaths were due predominantly to renal failure (n = 4), myocardial infarction in patients with nephropathy (n = 3) and sudden unexpected death (n = 3). The chief symptoms of autonomic neuropathy--diarrhoea, postural hypotension and gustatory sweating, were very persistent but did not necessarily deteriorate or become disabling in the majority of patients. The development of autonomic symptoms in asymptomatic patients with abnormal heart rate variability was uncommon over a decade.