PDF(Pubmed)
Abstract：
Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive hyperemia and autonomic activity in type 2 diabetes patients with and without CAN was performed. Results: Five articles showed differences in RH between healthy subjects and diabetic patients with and/or without neuropathy, while one study did not show such differences between healthy subjects and diabetic patients, but patients with diabetic ulcers had lower RH index values compared to healthy controls. Another study found no significant difference in blood flow after a muscle strain that induced reactive hyperemia between normal subjects and non-smoking diabetic patients. Four studies measured reactive hyperemia using peripheral arterial tonometry (PAT); only two found a significantly lower endothelial-function-derived measure of PAT in diabetic patients than in those without CAN. Four studies measured reactive hyperemia using flow-mediated dilation (FMD), but no significant differences were reported between diabetic patients with and without CAN. Two studies measured RH using laser Doppler techniques; one of them found significant differences in the blood flow of calf skin after stretching between diabetic non-smokers and smokers. The diabetic smokers had neurogenic activity at baseline that was significantly lower than that of the normal subjects. The greatest evidence revealed that the differences in RH between diabetic patients with and without CAN may depend on both the method used to measure hyperemia and that applied for the ANS examination as well as the type of autonomic deficit present in the patients. Conclusions: In diabetic patients, there is a deterioration in the vasodilator response to the reactive hyperemia maneuver compared to healthy subjects, which depends in part on endothelial and autonomic dysfunction. Blood flow alterations in diabetic patients during RH are mainly mediated by sympathetic dysfunction. The greatest evidence suggests a relationship between ANS and RH; however, there are no significant differences in RH between diabetic patients with and without CAN, as measured using FMD. When the flow of the microvascular territory is measured, the differences between diabetics with and without CAN become evident. Therefore, RH measured using PAT may reflect diabetic neuropathic changes with greater sensitivity compared to FMD.
摘要：
目的:探讨2型糖尿病伴或不伴心血管自主神经病变(CAN)患者自主神经系统与反应性充血(RH)的关系。方法：对有和没有CAN的2型糖尿病患者的反应性充血和自主神经活动的随机和非随机临床研究进行了系统评价。结果：五篇文章显示健康受试者与有和/或无神经病变的糖尿病患者之间的RH差异，虽然一项研究没有显示健康受试者和糖尿病患者之间的这种差异，但糖尿病溃疡患者的RH指数值低于健康对照组.另一项研究发现，在正常受试者和不吸烟的糖尿病患者之间，肌肉拉伤引起反应性充血后，血流量没有显着差异。四项研究使用外周动脉眼压法（PAT）测量了反应性充血；与没有CAN的患者相比，只有两项发现糖尿病患者的内皮功能衍生的PAT测量值显着降低。四项研究使用流动介导的扩张（FMD）测量反应性充血，但是有和没有CAN的糖尿病患者之间没有显著差异。两项研究使用激光多普勒技术测量了RH；其中一项发现糖尿病非吸烟者和吸烟者之间拉伸后小腿皮肤的血流量存在显着差异。糖尿病吸烟者在基线时的神经源性活动明显低于正常受试者。最大的证据表明，有和没有CAN的糖尿病患者之间RH的差异可能取决于用于测量充血的方法和用于ANS检查的方法以及患者中自主神经缺陷的类型。结论:在糖尿病患者中,与健康受试者相比，对反应性充血的血管扩张剂反应恶化，这部分取决于内皮和自主神经功能障碍。糖尿病患者RH期间的血流改变主要由交感神经功能障碍介导。最大的证据表明ANS和RH之间存在关系；然而，有和没有CAN的糖尿病患者的RH没有显着差异，使用FMD测量。当测量微血管区域的流量时，糖尿病患者与糖尿病患者之间的差异可以变得明显。因此,使用PAT测量的RH可以反映与FMD相比具有更大敏感性的糖尿病性神经病变。
