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糖尿病患者自主神经病变的发病率甚高,约为15%~40%,糖尿病合并心脏自主神经病变时,由于神经活动的平衡被打破,使心肌缺血、无痛性心肌梗塞及心脏性猝死的发生率增加。本文对50岁以上的糖尿病患者与健康人进行对比研究,以期及早发现糖尿病患者的自主神经病变,并进行于预治疗,降低死亡率。 相似文献
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糖尿病心脏自主神经病变与心血管事件发生的特点 总被引:1,自引:1,他引:0
糖尿病导致死亡的原因中.心血管事件是主要因素之一。虽然在强调糖尿病及其并发症的治疗过程中,也能改善糖尿病自主神经病变.但临床专门针对心脏自主神经病变(cardiac autonomic neuropathy,CAN)的检查和治疗仍较少,最容易被忽视^[1,2]。CAN的危害性隐匿、后果严重,相应的检查、诊断方法复杂,实际治疗方法和效果也并不理想^[3],这就要求在临床上充分了解其特征.才能及时诊断和作出恰当的处理。 相似文献
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由糖尿病引起的神经病变是神经发生病理改变最常的原因。而糖尿心脏自主神经病变又是糖尿病常见的并发症之一,其发病率占糖尿病总数的60%以上,重者可发生无痛性心肌梗死或心脏骤停致死,严重地影响了糖尿病患者的预后。为促进临床医生对其的掌握,笔者就近10年来的检测方法综述如下: 相似文献
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糖尿病心脏自主神经病变与室性心律失常 总被引:2,自引:1,他引:2
糖尿病自主神经病变(diabetic autonomic neuropathv,DAN)是一组由自主神经功能和(或)结构受损引发的征候群,主要累及心血管、胃肠道和泌尿生殖系统,具有起病隐匿、逐渐进展、可于症状出现前发生、甚少自行缓解的临床特征。其中,糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,DCAN)危害尤为严重,可以引起无痛性心肌缺血、心肌梗死及恶性心律失常甚至心源性猝死,从而引起医学工作者广泛关注。 相似文献
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2型糖尿病患者无症状性心肌缺血与自主神经病变关系的探讨 总被引:1,自引:0,他引:1
为了解无症状性心肌缺血 (SMI)的 2型糖尿病 (T2 DM)者心脏自主神经病变 (CAN)及其他自主神经病变的发生情况 ,同时排除高血压这一重要干扰因素 ,我们以血压正常且无心血管并发症临床表现的 T2 DM为研究对象 ,探讨 SMI与 CAN、胃肠及膀胱自主神经病变的关系 ,力图了解 SMI的危险因素。一、对象与方法1.研究对象的选择 :临床确诊 T2 DM(1997年 ADA标准 ) ,无高血压、无心血管疾病症状 ,如胸闷、心绞痛、晕厥等 ,ECG及 U CG正常 ,未服用降压药及扩血管药等 ,共5 8例。2 .方法 :每例受试者行如下各项检查 :SMI的检查 :用SPECT… 相似文献
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糖尿病周围神经病变是糖尿病患者较早出现也是最常见的慢性并发症,其中糖尿病自主神经病变可累及心血管、胃肠道和泌尿生殖系统等组织器官.糖尿病心脏自主神经病变(DCAN)可导致心率控制和血管血液动力学异常,显著增加糖尿病患者心律失常和猝死的风险[1],是2型糖尿病患者最严重的慢性并发症之一.但由于起病隐匿,早期无明显临床症状,常被忽视.近年来,随着人们对DCAN认识的提高,客观的检测手段使早期发现心脏自主神经功能异常成为可能,从而达到早期干预甚至逆转DCAN的目的. 相似文献
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糖尿病自主神经病变和糖尿病肾病关系探讨 总被引:6,自引:0,他引:6
自1945年Rundles首次报道糖尿病(DM)和自主神经病变(AN)关系以来,糖尿病自主神经病变(DAN)的研究已经取得很大进展。DAN是一组由自主神经功能和/或结构受损引起的症群,它的发病是糖代谢紊乱、血液流变学异常、缺血、自由基损害等多因素作用的结果[1],同时,DAN和其它因素一起促进了DM微血管病变的发生和发展。近年研究表明,DAN和糖尿病肾病(DN)、糖尿病视网膜病变(DR)存在密切关系[2,3],其中,DAN和DN的关系倍受人们重视。一、肾脏的神经支配自主神经是控制机体内脏功能的神经,它由交感和副交感神经组成… 相似文献
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糖尿病心血管自主神经病变 总被引:10,自引:0,他引:10
许樟荣 《国外医学:内分泌学分册》2004,24(2):84-86
糖尿病心血管自主神经病变发病率高,临床表现隐匿,预后差。典型的临床表现包括持续性心动过速、对运动及一些药物耐受性差、无症状性心肌缺血或无痛性心肌梗死、体位性低血压、心电图上心率变异小和QT间期延长等。心血管自主神经功能试验可及早地发现这类病变。 相似文献
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心率变异性频谱分析诊断糖尿病心脏自主神经病变 总被引:13,自引:0,他引:13
目的早期发现糖尿病自主神经病变。方法应用24小时动态心电图心率变异性频谱分析检查了56例糖尿病合并或不合并心脏自主神经病变患者。结果常规检查有心脏自主神经病变组(DM2组)入睡后高频(HF)成份明显<无自主神经病变组(DM1组)<正常对照组(P<0.001),而卧位及入睡后低频(LF)成份又高于对照组(P=0.0001)。从卧位到立位状态LF/HF比值上升幅度在DM1组小于对照组。结论心率变异性频谱分析是一种敏感的诊断糖尿病自主神经病变的方法 相似文献
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《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2019,13(2):1523-1528
AimsThe aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral neuropathy, and its association with peripheral nerve conduction abnormalities.MethodsA cross-sectional study at BIRDEM was conducted in 62 patients with type 2 diabetes mellitus having electrophysiologically diagnosed peripheral neuropathy. CAN was detected by four clinical tests - heart rate response to deep breathing and valsalva maneuver, blood pressure response to standing and sustained handgrip.ResultThe study showed that all patients had CAN – 14.52% had early, 26.67% had definitive and 59.68% had severe CAN. Patients with severe CAN had significantly reduced nerve conduction velocity and amplitude of peripheral nerves (sural 4.36 ± 12.77 vs 9.65 ± 17.77 m/s, p = 0.009; 2.23 ± 1.89 vs 3.01 ± 2.76 mV, p = 0.001; peroneal 7 ± 4.23 vs 8.53 ± 5.99 mV, p = 0.047; tibial 0.008 ± 0.03 vs 0.026 ± 0.05 mV, p = 0.009) and higher serum triglyceride levels (221.17 ± 120.61 vs 197.76 ± 68.43 mg/dl, p = 0.033).ConclusionDiabetic patients with peripheral neuropathy have CAN, the severity of which increases with worsening neuropathy. 相似文献
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糖尿病性心自主神经、末梢神经病变与糖尿病微血管并发症的关系 总被引:10,自引:0,他引:10
目的 观察糖尿病性心自主神经病变和末梢神经病变的患病率及其与其他糖尿病慢性并发症的关系。方法 利用心自主神经功能检测系统和神经电生理检测仪测定308例糖尿病患者(平均年龄49岁,平均HbA1c9.8%。平均病程14年)的心自主神经功能和肢体的末梢神经传导速度,皮肤痛温觉,振动觉,同时检测24h尿白蛋白排泄率和眼底视网膜照相。结果 糖尿病患者心自主神经病变患病率为47.1%。末梢神经病变患病率为54.2%,两者呈显著正相关。并与病程和糖尿病控制状况呈显著正相关。并发糖尿病性神经病变患者并发其他糖尿病慢性并发症的机率增高。结论 糖尿病性神经病变患病率较高,并与糖尿病其他慢性并发症密切相关。 相似文献
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《The Egyptian Heart Journal》2014,66(1):63-69
BackgroundPatients with long standing DM undergoing surgical interventions are put under great challenge as they may have cardiovascular and/or cardiac autonomic neuropathy (CAN). CAN is serious, often overlooked and under diagnosed, with possible arrhythmias and silent ischemia that threaten life.ObjectivesAssessment of CAN in long standing type 2 diabetic women undergoing major surgery.Study designCross sectional study.Patients and methodsOne hundred and six type 2 diabetic women scheduled for major surgery were assessed by the autonomic function tests. Only one hundred cases completed the study. CAN was assessed by analyzing HR variations during three standard tests (deep breathing, lying to standing and valsalva maneuver). Sympathetic functions were assessed by checking orthostatic hypotension. The CAN score of each patient was analyzed. Continuous 24 hour ECG monitoring (Holter) was done to evaluate ischemia, arrhythmia, QTc and QTd. Transthoracic Doppler echocardiography, stressing on LVH, diastolic and systolic dysfunctions were carried out. Cases were classified as mild (with only one abnormal test) or severe CAN when two or more abnormal function tests were present. Exclusion criteria include any systemic illness that can affect the study results or the autonomic functions, smoking and HTN.ResultsCAN was detected in 70% of the studied cases, and 70% were severe CAN. Postural hypotension was detected in 34% of the studied cases. QTc prolongation and QT dispersion were frequent. ECG and Doppler echocardiography changes of LVH were more prevalent among patients with CAN. Diabetics with CAN were significantly older had longer duration of DM and higher HbA1-c, higher pulse pressure, triglyceride, uric acid and urinary albumin excretion rate. They also had significant increased LVM index, diastolic dysfunction and myocardial ischemia.ConclusionMiddle aged women with long standing diabetes are vulnerable to CAN with postural hypotension and prolonged QTc intervals, QT dispersion, and increased LVMI and myocardial ischemia. Identification of CAN is crucial to exercise prevention against hazards of CV insults during stressful situation as surgery. 相似文献
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S Kageyama F Sasoh I Taniguchi I Homma H Saito Y Isogai 《Diabetes research and clinical practice》1985,1(4):243-246
A 53-year-old diabetic woman who had been diabetic for 14 years had recurrent episodes of cardiorespiratory arrest, which were easily resuscitated by a few chest massages. In 2 of 4 episodes a radial pulse was detected, so respiratory arrest was thought to be a primary event. Pentazocine was injected several hours prior to each of the 3 episodes. This was considered to be a precipitating factor. From the first episode of cardiorespiratory arrest, she received oxygen inhalation. When oxygen inhalation was withdrawn for 5-10 min, she became cyanotic. This was considered to be a sign of lack of hypoxic drive mediated by peripheral chemoreceptors. Ventilatory responses to hypercapnia was markedly decreased, indicating impaired central chemosensitivity. The possibility that impaired chemosensitivity could be a cause of respiratory arrest was suggested. 相似文献
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One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy. There is now clear evidence that suggests activation of inflammatory cytokines in diabetic patients and that these correlate with abnormalities in sympathovagal balance. Dysfunction of the autonomic system predicts cardiovascular risk and sudden death in patients with type 2 diabetes. It also occurs in prediabetes, providing opportunities for early intervention. Simple tests that can be carried out at the bedside with real‐time output of information – within the scope of the practicing physician – facilitate diagnosis and allow the application of sound strategies for management. The window of opportunity for aggressive control of all the traditional risk factors for cardiovascular events or sudden death with intensification of therapy is with short duration diabetes, the absence of cardiovascular disease and a history of severe hypoglycemic events. To this list we can now add autonomic dysfunction and neuropathy, which have become the most powerful predictors of risk for mortality. It seems prudent that practitioners should be encouraged to become familiar with this information and apply risk stratification in clinical practice. Several agents have become available for the correction of functional defects in the autonomic nervous system, and restoration of autonomic balance is now possible. 相似文献
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Summary Noradrenaline and isoproterenol kinetics using intravenous infusion of L-3H-NA and of3H-isoproterenol were investigated in eight Type 1 (insulin-dependent) diabetic patients without neuropathy and in eight Type 1 diabetic patients with autonomic neuropathy matched for age, sex and duration of diabetes. Resting plasma noradrenaline and adrenaline concentrations were reduced in patients with autonomic failure (p < 0.05). The metabolic clearance rate of noradrenaline was similar in both groups of patients, and the appearance rate of noradrenaline in plasma was reduced in patients with autonomic failure (p < 0.01). The disappearance of L-3H-noradrenaline from plasma after the infusion of L-3H-noradrenaline had been stopped was not different in patients with and without neuropathy. The metabolic clearance of isoproterenol was not influenced by the presence of autonomic failure and mean values were similar to the corresponding values for noradrenaline. Isoproterenol was only taken up by a non-neuronal uptake; this fording may indicate that neuronal uptake is not important for the inactivation of circulating catecholamines. Alternatively, because the non-neuronal uptake of isoproterenol is probably greater than that of noradrenaline, we cannot exclude the possibility that a small decrease in the neuronal uptake of noradrenaline was compensated for by a slightly higher non-neuronal uptake. 相似文献
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目的探讨2型糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,DCAN)的临床特征及相关危险因素。方法纳入2012年2月至2013年1月在广东省人民医院内分泌科就诊的2型糖尿病患者47例(按1999年世界卫生组织建议的糖尿病诊断标准),所有2型糖尿病患者进行葡萄糖耐量试验(OGTT)、胰岛素释放试验、血脂等分析,并以Ewing试验作为诊断DCAN的标准,对DCAN的患病情况、临床特征及可能的主要危险因素进行分析。同时,招募糖耐量正常者19例设为正常对照组。结果以Ewing试验为标准诊断心脏自主神经病变(cardiac autonomic neuropathy,CAN),正常对照组CAN的患病率仅为5.3%(1/19),2型糖尿病组为55.3%(26/47),两组比较差异有统计学意义(P=0.001)。2型糖尿病组中病程≤5年患者的DCAN患病率为45.2%(14/31),>5年患者为75.0%(12/16),两者比较差异有统计学意义(P=0.051)。2型糖尿病组中DCAN患者心率、收缩压、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、尿酸与正常对照组患者比较,差异有统计学意义(P<0.05)。静息心率>80次/min、收缩压>140 mm Hg(1 mm Hg=0.133 kPa)、空腹胰岛素>100 pmol/L、胰岛素抵抗指数>5.3或胰岛素分泌指数>102.65、尿酸>350μmol/L的患者的DCAN患病率均较正明显增加,均差异有统计学意义(P<0.05)。Logistic回归分析显示,糖化血红蛋白(HbA1c)(OR=11.788)、胰岛素抵抗指数(OR=17.211)、尿酸(OR=5.757)是DCAN的主要独立危险因素。结论 2型糖尿病患者是CAN的高危人群;糖化血红蛋白、胰岛素抵抗指数、尿酸是DCAN的主要独立危险因素。 相似文献
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通过对糖尿病病人心率变异功率谱定量分析,来评估氨氯地平对心脏植物神经病变的功能改善作用。;经8个月的治疗,结果表明:氨氯地平对心脏植物神经病变的功能具有改善作用,长期血糖控制水平和神经病变病程可能对其疗效产生影响,氨氯地平不影响包括山梨醇旁路的糖代谢,其降压效应与改善神经功能无明显相关。 相似文献
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目的结合Ewing试验和心率变异性(HRV)分析两种糖尿病心脏自主神经病变(DCAN)诊断方法,探讨基于Ewing试验的HRV分析对DCAN的临床价值。方法选取2012年2月至2013年1月于广东省人民医院内分泌科就诊的T2DM患者47例(T2DM组),及同期体检健康人群19名为正常对照(NC)组。所有受试者在Ewing试验过程中,予心脏搏动法监测HRV。分析静息状态及Ewing试验各项目期间HRV各参数变化,尝试探索基于Ewing试验的HRV诊断模式并评价其临床实用价值。结果以Ewing试验为诊断标准,T2DM组DCAN患病率为55.3%。随机纳入70%T2DM患者(预测组)的HRV指标得到Ewing-HRV诊断组合,包括握力试验时高频功率(HF)、静息状态时低频功率(LF)/HF、Valsalva动作时LF,该模式在其余30%T2DM患者(验证组)中,与Ewing试验诊断方法的符合性:Kappa=0.857,P=0.001,敏感性为100%,特异性为87.5%,阳性预测值为85.7%,阴性预测值为100%。结论基于Ewing的HRV诊断组合(Ewing-HRV法)与经典的Ewing试验的诊断效率高度吻合且该方法无创、受主观因素影响小、简单易行,在进一步探讨和分析的基础上可用于DCAN筛查。 相似文献