Cukrzycowa neuropatia układu sercowo-naczyniowego – objawy kliniczne, rozpoznanie i postępowanie terapeutyczne Artykuł przeglądowy
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cukrzycowa neuropatia układu sercowo-naczyniowego, diagnostyka, postępowanie terapeutyczne
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Abstrakt
Neuropatia układu sercowo-naczyniowego w przebiegu cukrzycy (CAN, cardiovascular autonomic neuropathy) jest jednym z najlepiej poznanych przewlekłych powikłań cukrzycy, istotnie zwiększającym ryzyko zgonu z przyczyn sercowo-naczyniowych. Hiperglikemia stanowi główną przyczynę uszkodzenia układu nerwowego przez aktywację szlaku poliowego, powoduje tworzenie końcowych zaawansowanych produktów glikacji oraz zwiększa stres oksydacyjny. Diagnostyka opiera się na wywiadach i klasycznych testach oceniających funkcjonowanie układu autonomicznego, np. teście głębokiego oddychania, próbie Valsalvy. W praktyce coraz częściej wykorzystuje się nowe, precyzyjne techniki – ocenę zmienności rytmu serca na podstawie analizy spektralnej czy badania SPECT. Odpowiednie leczenie i prewencja CAN, obejmujące terapię wieloczynnikową, obecnie stanowią jedyną możliwość ograniczenia rozwoju neuropatii. Zasadnicze znaczenie mają skuteczna kontrola glikemii, normalizacja ciśnienia krwi i dyslipidemii.
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Skowrońska , A., Dęmbe , K., Krasnodębski , P., Mrozikiewicz-Rakowska , B., Jasik , M., & Nehring , P. (2014). Cukrzycowa neuropatia układu sercowo-naczyniowego – objawy kliniczne, rozpoznanie i postępowanie terapeutyczne . Kardiologia W Praktyce, 8(3), 10-19. Pobrano z https://www.journalsmededu.pl/index.php/kwp/article/view/1526
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
Bibliografia
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2. Vinik A.I., Park T.S., Stansberry K.B. et al.: Diabetic neuropathies. Diabetologia 2000; 43: 957-973.
3. Feskens E.J., Kromhout D.: Glucose tolerance and the risk of cardiovascular disease: the Zutphen Study. J. Clin. Epidemiol. 1992; 45: 1327-1334.
4. Haffner S.M., Lehto S., Ronnema T. et al.: Mortality from coronary heart disease in subject with type 2 diabetes and non-diabetic subjects with and without prior myocardial infarction. N. Engl. J. Med. 1998; 339: 229-234.
5. Ziegler D., Gries F.A., Muhlen H. et al.: Prevalence and clinical correlates of cardio-vascular autonomic and peripheraldiabetic neuropathy in patients attending diabetes centers. The Diacan Multicenter Study Group. Diabet. Metab. 1993; 19: 143-151.
6. Vinik A.I., Maser R.E., Mitchell B.D., Freeman R.: Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 1553-1579.
7. Mustonen J., Uusitipa M., Mantysaari M. et al.: Changes in autonomic nervous function during the 4 year follow-up in middle-aged diabetic and non diabetic subjects initially free of coronary heart disease. J. Intern. Med. 1997; 241: 227-235.
8. Soedamah-Muthu S.S., Chaturvedi N., Teerlink T. et al.: Eurodiab Prospective Complications Study Group: plasma homocysteine and microvascular and macrovascular complications in type 1 diabetes a cross-sectional nested case-control study. J. Intern. Med. 2005; 258: 450-459.
9. Maser R.E., Mitchell B.D., Vinik A.I., Freeman R.: The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care 2003; 26: 1895-1901.
10. Ziegler D.: Cardiovascular autonomic neuropathy: clinical manifestations and measurement. Diabetes Reviews 1999; 7: 300‑315.
11. Ko S.H., Song K.H., Park S.A. et al.: Cardiovascular autonomic dysfunction predicts acute ischemic stroke in patients with type 2 diabetes mellitus: a 7-year follow-up study. Diabetic Med. 2008; 25: 1171-1177.
12. Ziegler D., Gries F.A., Spuler M. et al.; Cardiovascular Autonomic Neuropathy Multicenter Study Group: The epidemiology of diabetic neuropathy. J. Diabetes Complications 1992; 6: 49‑57.
13. Demaine A.G.: Polymorphisms of the aldose reductase gene and susceptibility to diabetic microvascular complications. Curr. Med. Chem. 2003; 10: 1389-1398.
14. Dyck P.J., Zimmerman B.R., Vilen T.H. et al.: Nerve glucose, fructose, sorbitol, myo-inositol and fiber degeneration and regeneration in diabetic neuropathy. N. Engl. J. Med. 1988; 319: 542-548.
15. Greene D.A., Lattimer-Greene S.A., Sima A.A.: Pathogenesis of diabetic neuropathy: role of altered phophoinositides metabolism. Crit. Rev. Neurobiol. 1989; 5: 143-219.
16. Greene D.A., Stevens M.J., Obrosova I., Feldman E.L.: Glucose-induced oxidative stress and programmed cell death in diabetic neuropathy. Eur. J. Pharmacol. 1999; 375: 217-223.
17. Hillis G.S., Woodward M., Rodgers A. et al.: Resting heart rate and the risk of death and cardiovascular complication in patients with type 2 diabetes mellitus. Diabetologia 2013; 55: 1283-1290.
18. Stettler C., Bearth A., Allemann S. et al.: QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up. Diabetologia 2007; 50: 186-194.
19. Position paper. Orthostatic hypotension, multiple system atrophy (the Shy Drager Syndrome). J. Auton. Nerv. Syst. 1996; 58: 123-124.
20. Freeman R., Landsberg L., Young J.: The treatment of neurogenic orthostatic hypotension with 3,4-DL-threo-dihydroxyphenylserine: a randomized, placebo-controlled, crossover trial. Neurology 1999; 53: 2151-2157.
21. Vinik A., Erbas T.: Neuropathy. W: Handbook of Exercise in Diabetes. 2nd ed. Ruderman N., Devlin J.T., Schneider S.H., Kriska A. (red.). American Diabetes Association; Alexandria, Va, 2001: 463-496.
22. Tsutsu N., Nunoi K., Yokomizo Y. et al.: Relationship between glycemic control and orthostatic hypotension in type 2 diabetes mellitus – a survey by the Fukuoka Diabetes Clinic Group. Diabetes Res. Clin. Pract. 1990; 8: 115-123.
23. Stewart J.M., Medow M.S., Montgomery L.D.: Local vascular responses affecting blood flow in postural tachycardia syndrome. Am. J. Physiol. Heart Circ. Physiol. 2003; 285: H2749-H2756.
24. Okin P.M., Devereux R.B., Lee E.T. et al.: Electrocardiographic repolarization complexity and abnormallity predict all- cause and cardiovascular morbility in diabetes: the strong HEARt Study. Diabetes 2004; 53: 434-440.
25. Veglio M., Borra M., Stevens L.K. et al.: The relation between QTc interval prolongation and diabetic complications: the EURODIAB IDDM Complications Study Group. Diabetologia 1999; 42: 68-75.
26. Langen K.J., Ziegler D., Weise F. et al.: Evaluation of QT interval length, QT dispersion and myocardial m-iodobenzylguanidine uptake in insulin-dependent diabetic patients with and without autonomic neuropathy. Clin. Sci. (Lond.) 1997; 93(4): 325-333.
27. Giunti S., Grazziela B., Lillaz E.: Incidence and risk factors of prolonged Qtc Interval in type 1 Diabetes. Diabetes Care 2007; 8: 2057-2062.
28. Wackers F.J., Young L.H., Inzucchi S.E. et al.; Detection of Ischemia in Asymptomatic Diabetics Investigators: Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 2004; 27: 1954-1961.
29. Ewing D.J., Clarke B.F.: Diabetic autonomic neuropathy: present insights and future prospects. Diabetes Care 1986; 9: 648-665.
30. Ewing D.J., Martyn C.N., Young R.J., Clarke B.F.: The value of cardiovascular autonomic function tests: 10 years’ experience in diabetes. Diabetes Care 1985; 8: 491-498.
31. Latini A., Martin L.S., Limiti G. et al.: Autonomic neuropathy in a diabetic population. Validity of cardiovascular tests and correlations with the complications. Recenti. Prog. Med. 2000; 91: 562-566.
32. The Diabetes Control and Complications Trial Research Group: The effect of intensive diabetes therapy on measures od autonomic nervous system function in the Diabetes Control and Complication Trail (DCCT). Diabetologia 1998; 41: 416-423.
33. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703-713.
34. Gaede P., Vedel P., Parving H.H.: Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999; 353: 617-622.
35. Ametov A.S., Barinov A., Dyck P.J. et al.: The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care 2003; 26: 770-776.
36. Thioctsaure I.V.: Bessert die Symptome bei sensiblen diabetischen Neuropathien. Die ALADIN studie. Munchener Medizinische Wochenschrift 1996; 16: 4-8.
37. Komori H., Oi K., Takahashi D. et al.: The effect of epalrestat in cardiac sympathetic nerve dysfunction with type 2 diabetes (abstract). Diabetologia 2004; 47(Suppl. 1): A368.
38. Ikeda T., Iwata K., Tanaka Y.: Long-term effect of epalrestat on cardiacautonomic neuropathy in subjects with non-insulin dependent diabetes mellitus. Diabetes Res. Clin. Pract. 1999; 43: 193-219.
39. Malik R.A., Williamson S., Abbott C. et al.: Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998; 352: 1978-1981.
40. Reja A., Tesfaye S., Harris N.D. et al.: Is ACE inhibition with lisinopril helpful in diabetic neuropathy? Diabet. Med. 1995; 12(4): 307-309.
41. Ebbehoj E., Poulsen P.L., Hansen K.W. et al.: Effects on heart rate variability of metoprolol supplementary to ongoing ACE-inhibitor treatment in type 1 diabetic patients with abnormal albuminuria. Diabetologia 2002; 45: 965-975.
42. Sakata K., Shirotani M., Yoshida H. et al.: Effects of amlodypine and clinidipine on cardiac sympathetic nervous system and neurohormonal status is essential hypertension. Hypertension 1999; 33(6): 1447-1452.
43. Howorka K., Pumprla J., Haber P. et al.: Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc. Res. 1997; 34: 206-214.
2. Vinik A.I., Park T.S., Stansberry K.B. et al.: Diabetic neuropathies. Diabetologia 2000; 43: 957-973.
3. Feskens E.J., Kromhout D.: Glucose tolerance and the risk of cardiovascular disease: the Zutphen Study. J. Clin. Epidemiol. 1992; 45: 1327-1334.
4. Haffner S.M., Lehto S., Ronnema T. et al.: Mortality from coronary heart disease in subject with type 2 diabetes and non-diabetic subjects with and without prior myocardial infarction. N. Engl. J. Med. 1998; 339: 229-234.
5. Ziegler D., Gries F.A., Muhlen H. et al.: Prevalence and clinical correlates of cardio-vascular autonomic and peripheraldiabetic neuropathy in patients attending diabetes centers. The Diacan Multicenter Study Group. Diabet. Metab. 1993; 19: 143-151.
6. Vinik A.I., Maser R.E., Mitchell B.D., Freeman R.: Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 1553-1579.
7. Mustonen J., Uusitipa M., Mantysaari M. et al.: Changes in autonomic nervous function during the 4 year follow-up in middle-aged diabetic and non diabetic subjects initially free of coronary heart disease. J. Intern. Med. 1997; 241: 227-235.
8. Soedamah-Muthu S.S., Chaturvedi N., Teerlink T. et al.: Eurodiab Prospective Complications Study Group: plasma homocysteine and microvascular and macrovascular complications in type 1 diabetes a cross-sectional nested case-control study. J. Intern. Med. 2005; 258: 450-459.
9. Maser R.E., Mitchell B.D., Vinik A.I., Freeman R.: The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care 2003; 26: 1895-1901.
10. Ziegler D.: Cardiovascular autonomic neuropathy: clinical manifestations and measurement. Diabetes Reviews 1999; 7: 300‑315.
11. Ko S.H., Song K.H., Park S.A. et al.: Cardiovascular autonomic dysfunction predicts acute ischemic stroke in patients with type 2 diabetes mellitus: a 7-year follow-up study. Diabetic Med. 2008; 25: 1171-1177.
12. Ziegler D., Gries F.A., Spuler M. et al.; Cardiovascular Autonomic Neuropathy Multicenter Study Group: The epidemiology of diabetic neuropathy. J. Diabetes Complications 1992; 6: 49‑57.
13. Demaine A.G.: Polymorphisms of the aldose reductase gene and susceptibility to diabetic microvascular complications. Curr. Med. Chem. 2003; 10: 1389-1398.
14. Dyck P.J., Zimmerman B.R., Vilen T.H. et al.: Nerve glucose, fructose, sorbitol, myo-inositol and fiber degeneration and regeneration in diabetic neuropathy. N. Engl. J. Med. 1988; 319: 542-548.
15. Greene D.A., Lattimer-Greene S.A., Sima A.A.: Pathogenesis of diabetic neuropathy: role of altered phophoinositides metabolism. Crit. Rev. Neurobiol. 1989; 5: 143-219.
16. Greene D.A., Stevens M.J., Obrosova I., Feldman E.L.: Glucose-induced oxidative stress and programmed cell death in diabetic neuropathy. Eur. J. Pharmacol. 1999; 375: 217-223.
17. Hillis G.S., Woodward M., Rodgers A. et al.: Resting heart rate and the risk of death and cardiovascular complication in patients with type 2 diabetes mellitus. Diabetologia 2013; 55: 1283-1290.
18. Stettler C., Bearth A., Allemann S. et al.: QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up. Diabetologia 2007; 50: 186-194.
19. Position paper. Orthostatic hypotension, multiple system atrophy (the Shy Drager Syndrome). J. Auton. Nerv. Syst. 1996; 58: 123-124.
20. Freeman R., Landsberg L., Young J.: The treatment of neurogenic orthostatic hypotension with 3,4-DL-threo-dihydroxyphenylserine: a randomized, placebo-controlled, crossover trial. Neurology 1999; 53: 2151-2157.
21. Vinik A., Erbas T.: Neuropathy. W: Handbook of Exercise in Diabetes. 2nd ed. Ruderman N., Devlin J.T., Schneider S.H., Kriska A. (red.). American Diabetes Association; Alexandria, Va, 2001: 463-496.
22. Tsutsu N., Nunoi K., Yokomizo Y. et al.: Relationship between glycemic control and orthostatic hypotension in type 2 diabetes mellitus – a survey by the Fukuoka Diabetes Clinic Group. Diabetes Res. Clin. Pract. 1990; 8: 115-123.
23. Stewart J.M., Medow M.S., Montgomery L.D.: Local vascular responses affecting blood flow in postural tachycardia syndrome. Am. J. Physiol. Heart Circ. Physiol. 2003; 285: H2749-H2756.
24. Okin P.M., Devereux R.B., Lee E.T. et al.: Electrocardiographic repolarization complexity and abnormallity predict all- cause and cardiovascular morbility in diabetes: the strong HEARt Study. Diabetes 2004; 53: 434-440.
25. Veglio M., Borra M., Stevens L.K. et al.: The relation between QTc interval prolongation and diabetic complications: the EURODIAB IDDM Complications Study Group. Diabetologia 1999; 42: 68-75.
26. Langen K.J., Ziegler D., Weise F. et al.: Evaluation of QT interval length, QT dispersion and myocardial m-iodobenzylguanidine uptake in insulin-dependent diabetic patients with and without autonomic neuropathy. Clin. Sci. (Lond.) 1997; 93(4): 325-333.
27. Giunti S., Grazziela B., Lillaz E.: Incidence and risk factors of prolonged Qtc Interval in type 1 Diabetes. Diabetes Care 2007; 8: 2057-2062.
28. Wackers F.J., Young L.H., Inzucchi S.E. et al.; Detection of Ischemia in Asymptomatic Diabetics Investigators: Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 2004; 27: 1954-1961.
29. Ewing D.J., Clarke B.F.: Diabetic autonomic neuropathy: present insights and future prospects. Diabetes Care 1986; 9: 648-665.
30. Ewing D.J., Martyn C.N., Young R.J., Clarke B.F.: The value of cardiovascular autonomic function tests: 10 years’ experience in diabetes. Diabetes Care 1985; 8: 491-498.
31. Latini A., Martin L.S., Limiti G. et al.: Autonomic neuropathy in a diabetic population. Validity of cardiovascular tests and correlations with the complications. Recenti. Prog. Med. 2000; 91: 562-566.
32. The Diabetes Control and Complications Trial Research Group: The effect of intensive diabetes therapy on measures od autonomic nervous system function in the Diabetes Control and Complication Trail (DCCT). Diabetologia 1998; 41: 416-423.
33. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703-713.
34. Gaede P., Vedel P., Parving H.H.: Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999; 353: 617-622.
35. Ametov A.S., Barinov A., Dyck P.J. et al.: The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care 2003; 26: 770-776.
36. Thioctsaure I.V.: Bessert die Symptome bei sensiblen diabetischen Neuropathien. Die ALADIN studie. Munchener Medizinische Wochenschrift 1996; 16: 4-8.
37. Komori H., Oi K., Takahashi D. et al.: The effect of epalrestat in cardiac sympathetic nerve dysfunction with type 2 diabetes (abstract). Diabetologia 2004; 47(Suppl. 1): A368.
38. Ikeda T., Iwata K., Tanaka Y.: Long-term effect of epalrestat on cardiacautonomic neuropathy in subjects with non-insulin dependent diabetes mellitus. Diabetes Res. Clin. Pract. 1999; 43: 193-219.
39. Malik R.A., Williamson S., Abbott C. et al.: Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998; 352: 1978-1981.
40. Reja A., Tesfaye S., Harris N.D. et al.: Is ACE inhibition with lisinopril helpful in diabetic neuropathy? Diabet. Med. 1995; 12(4): 307-309.
41. Ebbehoj E., Poulsen P.L., Hansen K.W. et al.: Effects on heart rate variability of metoprolol supplementary to ongoing ACE-inhibitor treatment in type 1 diabetic patients with abnormal albuminuria. Diabetologia 2002; 45: 965-975.
42. Sakata K., Shirotani M., Yoshida H. et al.: Effects of amlodypine and clinidipine on cardiac sympathetic nervous system and neurohormonal status is essential hypertension. Hypertension 1999; 33(6): 1447-1452.
43. Howorka K., Pumprla J., Haber P. et al.: Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc. Res. 1997; 34: 206-214.