Diabetes Care:痛性糖尿病神经病变与“非杓型”血压相关

2014-07-15 Elizabeth(编译) 睿医资讯

新近一项研究发现,痛性糖尿病多发性神经病(PDPN)与夜间血压(BP)增高有关,这种相关性独立于疼痛相关的共患病。相关研究结果由来自意大利罗马第二大学的Cinzia D'Amato及其同事于6月26日在线发表于《糖尿病护理(Diabetes Care)》杂志。 研究负责人Vincenza Spallone, MD说:“PDPN是一种常见并发症,可对睡眠、情绪和生活质量产生极大影响。但该病通常未能

新近一项研究发现,痛性糖尿病多发性神经病(PDPN)与夜间血压(BP)增高有关,这种相关性独立于疼痛相关的共患病。相关研究结果由来自意大利罗马第二大学的Cinzia D'Amato及其同事于6月26日在线发表于《糖尿病护理(Diabetes Care)》杂志。

研究负责人Vincenza Spallone, MD说:“PDPN是一种常见并发症,可对睡眠、情绪和生活质量产生极大影响。但该病通常未能被确诊,且治疗不足。本项研究指出了另一个需要大家注意该糖尿病并发症的原因,并支持了应将糖尿病周围神经痛视作心血管风险增高条件之一的观点。”

新发现:PDPN与夜间收缩压增高相关


这项临床试验共计纳入113例糖尿病患者,其中34例为PDPN、33例具有无痛性糖尿病多发性神经病、46例无DPN。患有PDPN的患者神经病症状和体征评分比无痛性DPN患者更高,但两组患者在心血管自主神经反射检查(CART)中结果相似。

PDPN组患者夜间收缩压为130.4 mmHg,高于其他两组患者——无痛性DPN组为124.2 mmHg(P< 0.05),非DPN组为119.9 mmHg(P < 0.0001)。

与此同时,PDPN组的收缩压与舒张压在夜间的变动较非DPN组更小(收缩压5.5 vs 8.6 mmHg,P <0.05;舒张压10.8 vs 14.2 mmHg,P < 0.05)。

PDPN组与非DPN组在救护车BP监控结果方面无差异。

“非杓型”即夜间BP未正常回落,这种现象发生于8例患者(7%)中,且与PDPN状况高度相关,这一现象通常伴随CART评分增高(3.0 vs 1.3,P = 0.020)

在逐步回归分析中,直立性低血压、阻塞性睡眠呼吸暂停(OSA)风险增高、神经性疼痛筛查结果均为夜间收缩压改变(P =0.0001)和夜间收缩压水平(P < .0001)的独立决定因素。

夜间疼痛的刺激使BP维持在较高水平


本研究的创新结果是发现了糖尿病周围神经痛与夜间收缩压水平较高及其非杓型改变相关,且这一相关性与疼痛相关的睡眠问题及糖尿病并发症无关。

这一结果很可能提示了在PDPN患者中夜间疼痛本身可作为应激原而诱发夜间交感神经反应,进而加重已存在的交感-迷走张力失衡,最终抑制BP在夜间回落。

该发现强调了控制心血管危险因素的重要性,同时提出了对患者进行适当神经性疼痛治疗的必要性。

原始出处:


D'Amato C1, Morganti R1, Di Gennaro F1, Greco C1, Marfia GA2, Spallone V3.A Novel Association Between Nondipping and Painful Diabetic Polyneuropathy.Diabetes Care. 2014 Jun 26. pii: DC_140528. [Epub ahead of print]

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    2015-04-11 x35042875

    糖尿病肾病进展风险的关系没有发现。

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    2014-11-09 智智灵药
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    2014-07-17 axin012
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