目的:我们调查了胃肠道症状-以联合加权症状评分(CWSS)评估-糖尿病自主神经病变(DAN)之间的关联,1型和2型糖尿病的远端对称性多发性神经病(DSPN)。
方法:在三级门诊进行的横断面研究。CWSS基于问卷计算:胃轻瘫综合症状指数(GCSI)和胃肠道症状评分(GSRS)。DAN和DSPN使用复合自主神经症状评分31(COMPASS-31)问卷进行了处理,心脏自主神经反射试验(CART),电化学皮肤电导(ESC),振动感知阈值(VPT),密歇根神经病筛查仪(MNSI),疼痛和热感觉。分析根据年龄进行了调整,性别,糖尿病持续时间,吸烟,LDL-胆固醇,HbA1C和收缩压。1型和2型糖尿病分别进行评估。
结果:我们纳入了566例1型糖尿病患者和377例2型糖尿病患者。平均±SD年龄为58±15岁,女性为565(59.9%)。1型糖尿病患者143例(25%)和2型糖尿病患者142例(38%)存在高CWSS。在高分组中,通过COMPASS-31(p<0.001)DAN的几率更高。对于1型糖尿病,高CWSS组发生心脏自主神经病变的几率较高.1型糖尿病患者VPT和MNSI的DSPN几率,通过ESC,高CWSS组2型糖尿病患者的VPT和疼痛感觉较高。
结论:通过COMPASS-31和振动感知,高症状评分与神经病变相关。胃肠道症状负担与糖尿病类型之间的其他神经病变测试不一致。
We investigated associations between gastrointestinal symptoms - evaluated as a combined weighted symptom score (CWSS) - Diabetic autonomic neuropathy (DAN), and distal symmetrical polyneuropathy (DSPN) in type 1 and type 2 diabetes.
Cross-sectional study in a tertiary outpatient clinic. CWSS was calculated based on questionnaires: gastroparesis composite symptom index (GCSI) and gastrointestinal symptom rating score (GSRS). DAN and DSPN were addressed using the composite autonomic symptom score 31 (COMPASS-31) questionnaire, cardiac autonomic reflex tests (CARTs), electrochemical skin conductance (ESC), vibration perception threshold (VPT), Michigan Neuropathy Screening Instrument (MNSI), pain- and thermal sensation. Analyses were adjusted for age, sex, diabetes duration, smoking, LDL-cholesterol, HbA1C and systolic blood pressure. Type 1 and type 2 diabetes were evaluated separately.
We included 566 with type 1 diabetes and 377 with type 2 diabetes. Mean ± SD age was 58 ± 15 years and 565 (59.9 %) were women. A high CWSS was present in 143 (25 %) with type 1 and 142 (38 %) with type 2 diabetes. The odds of DAN by COMPASS-31 (p < 0.001) were higher in the high score group. For type 1 diabetes, odds of cardiac autonomic neuropathy were higher in the high CWSS group. The odds of DSPN by VPT and MNSI in type 1 diabetes, and by ESC, VPT and pain sensation in type 2 diabetes were higher in the high CWSS group.
A high symptom score was associated with neuropathy by COMPASS-31 and vibration perception. Gastrointestinal symptom burden associated inconsistently with other neuropathy tests between diabetes types.