Clinical consequences of cardiovascular autonomic neuropathy in diabetic patients
Clinical consequences of cardiovascular autonomic neuropathy in diabetic patients
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DOI：
10.1007/s00592-003-0122-y
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发表时间：
2003-12-01
影响因子：
3.8
通讯作者：
Jermendy, G
中科院分区：
文献类型：
--
作者：
Jermendy, G
在糖尿病患者中可以观察到心血管自主神经病变（CAN）的广泛临床后果，并有助于糖尿病心脏的临床表现。静息心率和心血管反射以及昼夜心率变异性可能会改变CAN糖尿病。此外，血压也受到交感迷走神经失衡的影响。体位性低血压是糖尿病CAN患者的临床特征。在某些病例中还观察到无痛性心肌梗死、局部缺血和左心室功能障碍。心脏副交感神经和交感神经支配受损以及QT间期延长可能在糖尿病患者猝死的发病机制中起部分作用。由于异常的心血管反应，手术干预和麻醉的风险增加。CAN的临床症状和体征应被评估为严重的糖尿病并发症，在某些情况下治疗是困难的。总之，CAN的症状和体征在糖尿病患者中预后不良。
A wide range of clinical consequences of cardiovascular autonomic neuropathy (CAN) can be observed in diabetic patients and contributes to the clinical picture of the diabetic heart. Resting heart-rate and cardiovascular reflexes as well as circadian heart rate variability may be altered by CAN in diabetes. Moreover, blood pressure is also influenced by sympathovagal imbalance. Postural hypotension is a clinical characteristic in diabetic subjects with CAN. Painless myocardial infarction, ischaemia and left ventricular dysfunction are also observed in some cases. Impairment of cardiac parasympathetic and sympathetic innervation as well as QT-interval prolongation may play a partial role in the pathogenic mechanism of sudden unexpected death in diabetic patients. The risk of surgical intervention and that of anaesthesia are increased due to abnormal cardiovascular reactions. Clinical symptoms and signs of CAN should be assessed as severe diabetic complication and the therapy is difficult in some cases. Taken together, symptoms and signs of CAN carry a poor prognosis in diabetic patients.