100例2型糖尿病患者交感神经皮肤反应研究

目的探讨交感神经皮肤反应(SSR)检测在评价2型糖尿病(T2DM)自主神经损害中的价值.方法对100例T2DM患者进行SSR检测,30例健康志愿者作为对照.结果2组SSR的起始潜伏期、N波潜伏期、波幅、面积比较差异有显著性意义(P＜0.05),P波潜伏期差异无显著性意义(P＞0.05).T2DM组72例(72%)患者至少有一肢SSR异常.血糖控制满意组和血糖控制不良组比较,起始和N波潜伏期差异有统计学意义(P＜0.05),波幅和面积无显著性意义(P＞0.05).T2DM组病程＜5年与病程≥5年比较,潜伏期、波幅、面积差异均无统计学意义(P＞0.05).结论SSR可作为评价T2DM自主神经损害的客观电生理指标;T2DM患者SSR与血糖控制水平相关,与病程无关.     

2型糖尿病患者血清游离脂肪酸与心血管自主神经病变的相关性研究

目的分析2型糖尿病患者实验室检查及心血管自主神经病变情况,探讨血清游离脂肪酸与血管自主神经病变的关系。方法选取2型DM合并心血管自主神经病变患者20例为观察组,20例未合并心血管自主神经病变的DM患者为单纯DM组,20例健康志愿者为对照组,检测并比较血糖、血脂指标,FFA及心脏自主神经功能。结果观察组年龄显著高于其他2组,单纯DM组和观察组FPG、HbA1C、TG、TC、LDL-C显著高于对照组,HDL-C显著低于对照组,差异有统计学意义(P0.05)。观察组血清FFA高于单纯DM组(P0.05),单纯DM组显著高于对照组(P0.01)。单纯DM组及观察组深呼吸心率差、Valsalva指数及握拳舒张压差均显著低于对照组,立卧位收缩压差显著高于对照组,且与单纯DM组比较,观察组上述指标变化更显著,差异有统计学意义(P0.05)。观察组FFA与HbA1C、FPG、TG、LDL-C呈正相关,与HDL-C呈负相关(r=0.72、0.63、0.40、0.51、-0.43,P0.05)。FFA与心血管自主神经功能参数深呼吸心率差及Valsalva指数呈显著负相关(r=-0.54、0.65,P0.05)。结论 2型糖尿病患者血清游离脂肪酸与血糖、血脂及血管自主神经病变存在密切关系。     

动态心电图在2型糖尿病患者心脏自主神经功能评价中的应用价值研究

目的探讨动态心电图在2型糖尿病患者心脏自主神经功能评价中的临床应用价值。方法选择我院2013-05—2014-05间收治的2型糖尿病患者120例为研究对象,并根据传统心血管自主神经功能测定结果分为A组(自主神经损伤)62例和B组(自主神经正常)58例,采用动态心电图对心脏变时功能不全、心率变异(HRV)及心率震荡(HRT)等指标进行检查分析,评定该检查方法的临床应用价值。结果 (1)A组与B组的平均心率无明显差异(P0.05)。但A组的最快心率明显低于B组,最慢心率明显高于B组,2组差值以A组更低,差异具有统计学意义(P0.05);(2)A组的SDNN、SDANN、rMMSD等HRV指标均显著低于B组,而HRT指标中的震荡斜率(TS)也显著低于B组,差异具有统计学意义(P0.05)。但2组间的震荡初始(TO)值则无明显差异(P0.05)。结论采用动态心电图记录心脏变时性功能不全指标以及心率变异(HRV)、心率震荡(HRT)指标可准确评价2型糖尿病患者的心脏自主神经功能,具有一定的诊断价值,值得临床推广使用。     

后循环脑梗死患者静脉溶栓后的心率变异性及其预后评估

目的探讨后循环脑梗死(POCI)静脉溶栓患者的心率变异性(HRV),分析其对预后的评估价值。方法对86例脑梗死患者进行早期静脉溶栓治疗,根据梗死部位分为前循环梗死组(n=46)、后循环梗死组(n=40),根据治疗后三个月时随访改良Rankin量表(mRS)分为预后良好组(mRS评分≤2分,n=32)、预后不良组(mRS评分2分,n=16)。采用24h动态心电图记录HRV,比较不同组HRV相关指标的差异,及其与预后的相关性。结果前、POCI溶栓失败组中SDNN、SDANN、RMSSD及PNN50差异无统计学意义(P0.05);与溶栓失败组比较,两组溶栓成功组中HRV相关指标均显著升高,而POCI组的升高幅度高于前循环脑梗死组(P0.05)。POCI患者中,预后良好组SDNN、SDANN、RMSSD及PNN50均明显高于预后不良组(P0.05)。NIHSS评分与POCI患者SDNN、SDANN、RMSSD及PNN50均呈显著负相关(P0.05)。结论 POCI患者易出现自主神经功能受损和HRV降低,且与预后密切相关。早期溶栓治疗可有效提高HRV指标水平,调节自主神经功能。     

皮肤交感反应与2型糖尿病自主神经病变相关性研究

目的 探讨皮肤交感反应(sympathetic skin response,SSR)对2型糖尿病自主神经病变的诊断价值.方法 对111例2型糖尿病患者及30例健康体检者进行SSR及神经传导速度测定,检测糖化血红蛋白(hemoglobin A1c,HbAlc)等多项生化指标,同时分析与SSR异常有关的因素.结果 与对照组比较,病例组SSR潜伏期延长,波幅降低(P＜0.05).与病程＜5年组比较,5～10年组、病程≥10年组上肢SSR潜伏期延长(P＜0.05),而波幅变化无统计学差异(P＞0.05).各不同病程组间SSR异常率比较无统计学差异(P＞0.05).周围神经病变组SSR异常率高于无周围神经病变组(P＜0.05),自主神经症状的有无对SSR异常率无影响(P＞0.05).Logistic回归分析结果显示,HbAlc是2型糖尿病患者SSR异常的相关因素.结论 SSR可早期发现糖尿病患者自主神经功能损害,HbAlc是2型糖尿病患者SSR异常的相关因素.     

自主神经功能心率变异性与急性脑外伤的相关研究

目的 利用心率变异性(heart rate variability.HRV)作为判断自主神经活动的定量指标,分析脑外伤患者伤后自主神经活动功能情况.方法 采用的指标包括SDNN、SDANN、SDNN Index、RMSSD、HRV Triangular Index、TINN、PNN50、SDSD、NN间期直方图、NN问期差值直方图.结果 经本研究显示中、重度脑外伤患者存在明显的自主神经活动功能障碍,轻度脑外伤自主神经活动功能障碍不明显,为临床早期诊断脑外伤病人自主神经功能异常,预测病人预后,以及尽早实施临床治疗提供理论依据.结论 本研究提示中、重TBI患者存在明显的ANS功能障碍,脑外伤是影响STBI患者心脏血管自主神经活性的主要因素.结果 表明中、重TBI病人HRV分析指标明显低于对照组,且与预后转归有关,可作为中、重TBI病人预测其预后的重要指标.     

Hcy和Cys-C水平与糖尿病周围神经病变的相关性研究

目的 探讨2型糖尿病(T2DM)周围神经病变患者血浆同型半胱氨酸(Hcy)、胱抑素C(Cys-C)的水平变化及其意义。方法 选取2016年1月～2016年12月本院确诊的T2DM周围神经病变患者88例(DPN组),另选88例年龄、性别与之匹配的单纯T2DM患者(对照组),检测并比较2组的血浆Hcy、Cys-C的水平,采用非条件Logistic回归分析T2DM患者并发周围神经病变的危险因素。结果 DPN组的糖尿病病程、HbA1c测定值均高于对照组(P<0.05); DPN组的HDL-C水平低于对照组(P<0.05); DPN组的血浆Hcy、Cys-C的水平均高于对照组(P<0.05); 糖尿病患者并发周围神经病变的危险因素为糖尿病病程(OR=1.829)、HbA1c(OR=1.558)、Hcy(OR=1.629)、Cys-C(OR=1.733)(P<0.05)。结论 血浆Hcy、Cys-C高水平是糖尿病患者并发周围神经病变的独立危险因素。     

T2DM患者交感神经皮肤反应特征分析

目的探讨2型糖尿病(T2DM)患者的交感神经皮肤反应(SSR)改变特征.方法测定88例T2DM患者的上、下肢体的SSR改变特征;并分析与病程、糖基化血红蛋白(以下简称HbA1C)的关系.选正常人50例作为对照组.结果 T2DM患者的上、下肢SSR的异常率分别为68.5%、58.5%,明显高于正常对照组(P《0.05) ,进一步发现,病程越长,HbAIC水平越高,SSR异常率越高.结论 T2DM患者存在着广泛的植物神经神经病变,SSR技术有助于诊断.     

β-纤维蛋白原-455 G/A基因多态性与2型糖尿病脑梗死的关系

目的　探讨β 纤维蛋白原 45 5G/A( β Fg 45 5G/A)基因多态性与中国东北地区汉族 2型糖尿病脑梗死的关系。 方法　应用聚合酶链反应 限制性片段长度多态性 (PCR RFLP)方法 ,检测 2型糖尿病无大血管病变 (DM2 )组 67例、2型糖尿病合并脑梗死(DM2CI)组 72例和对照 (CON)组 69例 β Fg 45 5G/A基因的多态性 ,并测定血浆纤维蛋白原 (Fg)含量。 结果　经 χ2 检验 ,各基因型频率和等位基因频率在 3组之间均无显著性差异。DM2组血浆Fg水平 ( 3 15± 0 89)g/L与DM2CI组 ( 2 70± 1 5 0 )g/L和CON组 ( 2 62± 0 5 1)g/L比较均有显著性差异 ,DM2CI组血浆Fg水平与CON组比较无显著性差异。结论　本研究未发现 β Fg 45 5G/A基因多态性与DM2CI之间存在相关关系。血浆Fg水平升高可能是DM2患者脑梗死发病的危险因素之一。     

2型糖尿病并发糖尿病周围神经病变与代谢综合征的关系

目的 探讨2型糖尿病(T2DM)并发糖尿病周围神经病变(DPN)与代谢综合征(MS)的关系。方法 选取我院收治的T2DM患者95例,按是否并发MS进行分组,并发MS 45例为研究组,无MS为对照组50例。2组均进行电生理检查、MS相关指标的血液、尿液标本测定,统计2组DPN发生率,比较2组SCV和MCV及MS相关指标水平,并进行影响DPN的多因素Logistic回归分析。结果 研究组DPN发生率为62.22%,对照组为12.00%,差异有统计学意义(P0.01)。2组左右腓神经SCV、MCV比较有显著差异(P0.01)。2组TC、TG、LDL-C比较差异无统计学意义(P0.05),2hINS、UA、HbA1c、CRP、UAER水平比较有明显差异(P0.01)。多因素Logistic回归分析结果显示,HbA1c、UAER、2hINS、CRP等MS相关指标异常均为DPN的危险因素。结论 T2DM并发DPN与MS密切相关,MS相关指标,如HbA1c、UAER、2hINS等水平过高是导致DPN发生的高危因素,故临床在控制血糖的时候应注重患者MS相关指标的检测与调控。     

抑郁症与精神分裂症患者心率变异性的对照分析

目的探讨抑郁症与精神分裂症患者的心率变异性（HRV）的差异。方法对36例首次发作的抑郁症患者及年龄、性别与之相匹配的41例首次发作的精神分裂症患者分别进行短时程HRV检测,并对其心率变异指标SDNN、MSD、rMSSD、PNN50、LF、HF、LF/HF结果进行分析。结果抑郁症患者的时阈指标rMSSD（P〈0.05）、PNN50（P〈0.01）较精神分裂症显著降低,而两者之间的频阈分析指标无明显差异。结论抑郁症患者的自主神经功能失调较精神分裂症患者更严重。     

Standardized tests of heart rate variability for autonomic function tests in healthy Koreans

Heart rate variability (HRV) is a noninvasive measure of autonomic input to heart rate that has been successfully used to estimate modulation of autonomic tone. The authors investigated to determine the normal ranges as a standardized tests of heart rate variability (HRV) for autonomic function tests in a large sample of healthy Koreans. The study also evaluated the effects of age, sex, and heart rate (HR) on the results of HRV and the values of HRV in hypertension, diabetes, and obesity group. Six hundred and thirty-seven healthy subjects who visited the health improvement center for medical examination were evaluated. A standardized 5-min resting study, including spectral analysis of HR, was used to all participants after an overnight fast. HRV (SA-2000E, Medicore, Korea) was spectrally determined by three components: total-frequency (TF) component (0.01 to 0.5 Hz), low-frequency (LF) component (0.04 to 0.15 Hz), and high-frequency (HF) component (0.15 to 0.5 Hz). Also two component ratio (LF/HF) was calculated. Routine laboratory and physical examinations were used to eliminate cardiovascular diseases and neurological disorders. The determinants of short-period HRV in a random sample of 366 men and 271 women from healthy subjects were assessed. The mean age of these subjects was 45.1 +/- 10.7 years. The mean value of total power was 1106.9 +/- 1109.1 ms(2); SDNN was 35.9 +/- 15.5 ms; rMSSD was 27.3 +/- 15.6 ms for time domain analysis. The mean value of LF was 287.5 +/- 384.1 ms(2); HF was 227.0 +/- 284.4 ms(2); LF/HF was 2.2 +/- 3.4 for frequency domain analysis. Additionally, men showed that their TP, LF, and LF/HF values were significantly higher than women whereas SDNN, rMSSD, HF showed no significant differences between sexes. With increasing age, there was no significant decrease in HR. TP, SDNN, LF, and HF were significantly decreased when getting older. On the contrary, LF/HF had no significant difference related to age. The study confirmed that SDNN and rMSSD were significantly lower in hypertension and diabetes group. In conclusion, middle-aged men had more pronounced sympathetic influence than women in cardiac regulation, and HRV declined linearly with age. In addition, HRV reflecting the function of autonomic nervous system was decreased in hypertension and diabetes group.     

STANDARDIZED TESTS OF HEART RATE VARIABILITY FOR AUTONOMIC FUNCTION TESTS IN HEALTHY KOREANS

Heart rate variability (HRV) is a noninvasive measure of autonomic input to heart rate that has been successfully used to estimate modulation of autonomic tone. The authors investigated to determine the normal ranges as a standardized tests of heart rate variability (HRV) for autonomic function tests in a large sample of healthy Koreans. The study also evaluated the effects of age, sex, and heart rate (HR) on the results of HRV and the values of HRV in hypertension, diabetes, and obesity group. Six hundred and thirty-seven healthy subjects who visited the health improvement center for medical examination were evaluated. A standardized 5-min resting study, including spectral analysis of HR, was used to all participants after an overnight fast. HRV (SA-2000E, Medicore, Korea) was spectrally determined by three components: total-frequency (TF) component (0.01 to 0.5 Hz), low-frequency (LF) component (0.04 to 0.15 Hz), and high-frequency (HF) component (0.15 to 0.5 Hz). Also two component ratio (LF/HF) was calculated. Routine laboratory and physical examinations were used to eliminate cardiovascular diseases and neurological disorders. The determinants of short-period HRV in a random sample of 366 men and 271 women from healthy subjects were assessed. The mean age of these subjects was 45.1 ± 10.7 years. The mean value of total power was 1106.9 ± 1109.1 ms²; SDNN was 35.9 ± 15.5 ms; rMSSD was 27.3 ± 15.6 ms for time domain analysis. The mean value of LF was 287.5 ± 384.1 ms²; HF was 227.0 ± 284.4 ms²; LF/HF was 2.2 ± 3.4 for frequency domain analysis. Additionally, men showed that their TP, LF, and LF/HF values were significantly higher than women whereas SDNN, rMSSD, HF showed no significant differences between sexes. With increasing age, there was no significant decrease in HR. TP, SDNN, LF, and HF were significantly decreased when getting older. On the contrary, LF/HF had no significant difference related to age. The study confirmed that SDNN and rMSSD were significantly lower in hypertension and diabetes group. In conclusion, middle-aged men had more pronounced sympathetic influence than women in cardiac regulation, and HRV declined linearly with age. In addition, HRV reflecting the function of autonomic nervous system was decreased in hypertension and diabetes group.     

Heart rate variability in children with neurocardiogenic syncope

Abstract. In order to characterize the autonomic profile of syncopal children, we have studied heart rate variability (HRV) of 73 children, ages 11–18, with neurocardiogenic syncope and a positive outcome of head-up tilt testing (HUT).HRV was calculated over a 24-hour period for the time-domain indices (SDNN, SDANNi, SDNN, rMSSD, pNN50), and over 5-minute segments from night and day for frequency-domain indices (LF, HF, LF/HF). The obtained results were compared to reference values calculated for Polish children. 55% of the children had mixed response to HUT, 41% vasodepressor and 4% cardioinhibitory. Patients with syncope had significantly lower values of rMSSD and pNN50 in comparison to healthy children. Moreover, in the frequency-domain analysis they exhibited significantly higher LF and lower HF values. The day-night rhythm of HRV and the age-related changes of HRV were, however, similar in syncopal and healthy children. In addition to this, we found a significantly lower SDNN value in children with cardioinhibitory response during HUT in comparison to children with mixed response. We concluded that 1) based on HRV analysis children with neurocardiogenic syncope had alterations in basal autonomic balance, which indicated an increased sympathetic modulation in these patients, 2) syncopal children had adequate circadian rhythm of autonomic activity, 3) the changes of HRV indices with age in these groups are not altered in comparison to healthy children, 4) syncopal children may exhibit differences in HRV indices values depending on the kind of vasovagal response observed during HUT.     

Age, body mass index, and menstrual cycle influence young women’s heart rate variability

Heart rate variability (HRV) in women has been related independently to endogenous sex hormones, hormone replacement therapy, menopause, menstrual cycle, body mass index (BMI), and physical conditioning. However, the joint influence of all these factors has not been reported. The present study describes the relation between circadian variation HRV and assesses its association with BMI, age, and menstrual cycle in healthy young women. A multivariable analysis was performed to estimate the predictive variables involved in SDNN, pNN50, and rMSSD profile, using the classification and regression tree (CART) and the logistic regression models. It was found that the first predictive variable was age, which divided women in two groups: >29.5 years old and <29.5 years old. In the case of the SDNN, the second predictive variable was BMI; the highest values were observed in women younger than 23 years old, with a BMI less than 19.82 kg/m2 and during the follicular phase of her menstrual cycle. For pNN50 and rMSSD the second predictive variable was menstrual cycle for women younger than 29.5 years old. Thus, in this group of women, age was a major determinant of cardiac autonomic nervous modulation followed by the BMI. HRV may be better understood using a multivariable analysis that could mimic physiological conditions.     

降压治疗对老年高血压及合并脑梗死患者心率变异性的影响

目的研究不同程度降压对老年高血压及合并腔隙性脑梗死患者心率变异性的影响,探讨高血压不同病理状态下HRV变化的差异。方法选择老年原发性高血压(高血压组)及合并腔隙性脑梗死(腔梗组)患者各33例为观察对象;同期健康老年人自愿者(健康对照组)27例,测定降压治疗前后不同血压水平下心率变异性参数的变化。结果降压治疗前高血压并脑梗组和高血压组心率变异性的各时域指标均较正常组明显减小,其中高血压并脑梗组较高血压组减小更明显,但2组比较仅SDNNI和RMSSD差异有统计学意义(P<0.05)。降压治疗后无论高血压组或高血压并脑梗组各时域指标均有不同程度的增高,第2次降压较第1次降压后各组各时域指标增高更明显。第1次降压后和降压前比较,各时域指标仅高血压组SDANNI和PNN50差异有统计学意义(P<0.05);第2次降压后和降压前比较,高血压组SDNN、SDANNI和PNN50差异有统计学意义(P<0.05),高血压并脑梗组SDNN和PNN50亦有显著差异;第2次降压后与第1次降压后比较,仅SDNN有显著差异(P<0.05)。结论高血压及合并腔隙性脑梗死患者心率变异性均有不同程度降低,合理降压治疗可部分提高不同病理阶段高血压患者心率变异性,改善自主神经功能。     

Non-invasive assessment of cardioregulatory autonomic functions in children with epilepsy

OBJECTIVES: We aimed to evaluate the interictal cardiovascular autonomic functions in pediatric patients with idiopathic epilepsy, both partial and generalized. MATERIALS AND METHODS: The study included 25 patients with idiopathic epilepsy and 50 control subjects. Patients underwent five standardized clinical cardiovascular reflex autonomic tests [resting heart rate (HR), HR response to deep breathing and to Valsalva maneuver, the 30:15 ratio of HR response to standing, and blood pressure response to standing], as well as a 12 lead surface electrocardiogram. Heart rate variability (HRV) was tested via 24-h Holter monitoring and the time domain parameters (SDNN, PNN50, rMSDD) were assessed. Excretion of vanillyl mandelic acid and metanephrine was measured in 24-h urine collection. RESULTS: Clinical reflex autonomic tests showed mild dysfunction in 8%, moderate dysfunction in 44% and severe dysfunction in 4% of patients. The HRV parameter, SDNN, was reduced in all age groups, while rMSDD and PNN50 were reduced only in the older age group. Metanephrine levels were significantly reduced in the patients group. Patients with uncontrolled epilepsy had a significantly higher frequency of autonomic dysfunction as assessed by clinical scoring. CONCLUSION: Cardiac autonomic dysfunction is not uncommon in pediatric patients with epilepsy. Altered cardiovascular regulation seems to be related to the epilepsy itself rather than to the characteristics of the disorder.     

Short-term heart rate complexity is reduced in patients with type 1 diabetes mellitus

OBJECTIVE: The aim of this study was to test whether new heart rate variability (HRV) complexity measures provide diagnostic information regarding early subclinical autonomic dysfunction in diabetes mellitus (DM). METHODS: HRV in DM type 1 patients (n=17, 10f, 7m) aged 12.9-31.5 years (duration of DM 12.4+/-1.2 years) was compared to a control group of 17 healthy matched probands. The length of R-R intervals was measured over 1h using a telemetric ECG system. In addition to linear measures, we assessed HRV complexity measures, including multiscale entropy (MSE), compression entropy and various symbolic dynamic measures (Shannon and Renyi entropies, normalized complexity index (NCI), and pattern classification). RESULTS: HRV magnitude was significantly reduced in patients with DM. Several HRV complexity parameters (MSE at scales 2-4, Renyi entropy, NCI) were also significantly reduced in diabetics. MSE indices and compression entropy did not correlate with linear measures. CONCLUSIONS: The magnitude and complexity of HRV are reduced in young patients with DM, indicating vagal dysfunction. SIGNIFICANCE: The quantification of HRV complexity in combination with its magnitude may provide an improved diagnostic tool for cardiovascular autonomic neuropathy in DM.     

Reduced heart rate variability in chronic severe traumatic brain injury: Association with impaired emotional and social functioning,and potential for treatment using biofeedback

Heart rate variability (HRV) may provide an index of capacity for social functioning and may be remediated by HRV biofeedback. Given reductions in HRV are found following traumatic brain injury (TBI), the present study aimed to determine whether lower HRV in TBI is associated with social function, and whether HRV biofeedback might be a useful remediation technique in this population. Resting state HRV and measures of social and emotional processing were collected in 30 individuals with severe TBI (3–34?years post-injury) and 30 controls. This was followed by a single session of HRV biofeedback. HRV was positively associated with social cognition and empathy, and negatively associated with alexithymia for the TBI group. Both TBI and control groups showed significantly increased HRV on both time-domain (i.e., SDNN, rMSSD) and frequency-domain measures (LF, HF, LF:HF ratio) during biofeedback compared to baseline. These results suggest that decreased HRV is linked to social and emotional function following severe TBI, and may be a novel target for therapy using HRV biofeedback techniques.     

Comparison of electrophysiologic and autonomic tests in sensory diabetic neuropathy

We examined autonomic function in 46 patients with symmetric sensory non-insulin dependent diabetic neuropathy without autonomic symptoms and 31 age-matched control patients using the composite autonomic scoring scale (CASS) and electrophysiologic examination. The patients were divided into three groups by subjective severity of pain or numbness; 17 had slight pain or numbness, 15 had mild pain or numbness, and 14 had moderate pain or numbness. The patients in the moderate group had the following: a mild reduction in systolic and mean blood pressure (BP) within 1 minute of head-up tilt and a partial recovery after 5 minutes; an excessive fall in early phase II (IIe), an absence of late phase II (III) and reduced phase IV beat-to-beat BP responses to Valsalva maneuver (VM); a poor heart rate response to deep breathing; a reduced quantitative sudomotor axon reflex test (QSART) response in distal leg and foot; the highest CASS among the 3 groups; and reduced conduction velocity and amplitude in post-tibial nerve and sural nerve. The mild group had a mild reduction in BP during phase IIe and an absent phase III but normal phase IV overshoot during VM; a reduced QSART in the foot; a CASS between the moderate and slight groups; and reduced conduction velocity and amplitude in post-tibial nerve and reduced amplitude in sural nerve. The slight pain group had no abnormalities except for mild cardiovagal dysfunction. CASS gathered from all cases had a significant correlation with amplitude of sural nerve. These results suggest that the patients with symmetric sensory diabetic neuropathy may also have autonomic dysfunction, although they did not have any obvious autonomic symptoms, and that abnormalities in autonomic function parallel changes in somatic function in peripheral nerve. The CASS may be a sensitive tool, similar to the neurophysiologic test, for assessing diabetic neuropathy.