背景:自主神经病变(AN)的症状在糖尿病和晚期肾病患者中很常见。然而,通过单一的实验室或侵入性测试无法检测到自主神经病变的不同领域。COMPASS31,一项新的自我评估测试,通过分数判断AN的表现时,不仅在心脏自主神经病变中而且在不同的子领域中都显示出可靠的结果。
方法:招募了一百八十三名患有或不患有糖尿病的患者,其中119人接受了永久性透析治疗(HD),64例患者作为对照(eGFR>60ml/min。)使用COMPASS评估了31种不同的AN症状(立位不耐受,血管舒缩,分泌运动,胃肠,膀胱,瞳孔运动变化)并转换为AN分数。
结果:与对照组相比,透析患者的AN更为明显(AN评分27,5vs.10,0;p<0,01)。这些差异也存在于AN的每个子域(直立不耐受,血管舒缩,分泌运动,胃肠,膀胱,瞳孔运动变化;所有子域的p<0.05)。在糖尿病患者中,AN症状与糖尿病持续时间之间存在很强的相关性(相关系数r=0,45,p<0,001)。当前血糖控制(HbA1c),体重指数(BMI),性别,在比较透析患者和对照组时,身高对AN没有影响。C反应蛋白(CRP)与AN评分呈正线性相关(相关系数r=0,21;p<0,05)。
结论:在透析患者中,AN的症状不仅在总体上而且在所有不同的神经病变领域都更为明显。持久的糖尿病疾病促进了AN的发展,糖尿病病程与AN呈正相关。未来的纵向研究可能有助于通过易于使用的COMPASS31来确定透析患者的高心血管疾病和死亡风险,而无需使用侵入性和耗时的方法来诊断AN。
BACKGROUND: Symptoms of autonomic neuropathy (AN) are common in patients with diabetes and advanced renal disease. As yet different domains of autonomic neuropathy cannot be detected by a singular laboratory or invasive test. COMPASS 31, a new self-assessment test, has shown reliable results not only in cardiac autonomic neuropathy but also in different sub-domains when judging manifestation of AN by scores.
METHODS: One hundred eighty-three patients with or without diabetes were enrolled, one hundred nineteen of them were treated with permanent dialysis therapy (HD), sixty-four patients served as controls (eGFR > 60 ml/min.) Using COMPASS 31 different symptoms of AN were assessed (orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, pupillomotor changes) and transferred into AN-scores.
RESULTS: AN was more pronounced in dialysis patients compared with controls (AN-score 27,5 vs. 10,0; p < 0,01). These differences were present also in every sub-domain of AN (orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, pupillomotor changes; p < 0,05 for all sub-domains). In diabetic patients there was a strong correlation between symptoms of AN and diabetes duration (correlation coefficient r = 0,45, p < 0,001). Current glycemic control (HbA1c), body mass index (BMI), sex, and height had no influence on AN when comparing dialysis patients and controls. C-reactive protein (CRP) showed a positive linear correlation with AN-scores (correlation coefficient r = 0,21; p < 0,05).
CONCLUSIONS: Symptoms of AN are more pronounced in dialysis patients not only in total but also in all different domains of neuropathic changes. Longlasting diabetic disease promotes development of AN, as duration of diabetes was positively correlated with AN. Future longitudinal studies might help to identify the high cardiovascular and mortality risk in dialysis patients by the easy-to-use COMPASS 31 without need of invasive and time-spending methods for diagnosing AN.