糖尿病における呼吸性心拍数の変動  糖尿病性自律神経障害の早期指標:糖尿病性自律神経障害の早期指標 Variations in Heart Rate During Deep Breathing as an Early Index of Diabetic Autonomic Neuronathy

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糖尿病性自律神経障害の一指標として, 深呼吸時の心拍数の変動を糖尿病患者57名 (年齢21歳~59歳, IDDM7名, NIDDM50名), および健常人78名につき測定し検討した。<BR>1分間6回の深呼吸 (5秒間吸気, 5秒間呼気) 時の心電図より脈拍最大変化量の平均値を算出しΔHRとした.健常人ではΔHRと年齢との間に負の相関を認めたが, 全例でΔHRは毎分10拍以上であった.従ってΔHRが毎分10拍未満のものを異常低下とした.糖尿病群ではΔHRと年齢とに相関はなかった.罹病期間5年以下の群では41%(9/22), 5年をこえる群では71%(25/35) にΔHRの異常低下を見た.罹病期間が5年をこえながらΔHRが正常域にとどまった7例中6例は食事療法のみ, あるいは経口剤で治療されていた.他の糖尿病性合併症との関係では, 網膜症, 持続性蛋白尿, アキレス腱反射消失, 振動覚低下等を有する群ではΔHRの低下が著明であったが, これらの合併症を認めぬ者でも既にそれぞれ23%, 38%, 23%, 31%でΔHRが低下していた、起立血圧下降とΔHRの問には有意の負の相関を認めた.罹病期間ごとにΔHR低下の頻度を他の糖尿病性合併症のそれと比べると, 罹病期間5年以下の群ではΔHRの低下は41%に見られ, 他の合併症より高率であった.これらの成績は潜在性の自律神経障害は糖尿病の早期より発現しうる合併症であり, ΔHRはこれを知る上で簡便かつ有意義な検査法であることを示す.

The variation in heart rate during deep breathing (JHR) was measured in 57 diabetic patients (7 insulin-dependent and 50 non insulin-dependent) and was evaluated as an index of autonomic neuropathy of diabetes. The value of ZIHR was consistently higher than 10 beats/min in all 78 nondiabetic controls and it was significantly correlated inversely with age. In diabetic patients, however, it was not correlated with age.Δ HR of less than 10 beats/min (low JHR) was observed in 41% of the patients with diabetes of less than 5 years duration and its frequency was higher than that of other diabetic complications; retinopathy (14 %), proteinuria (18 %), absent Achilles tendon reflex (22 %), and decreased vibratory sense (22 %). The incidence of patients with low JHR was 71 % in the group with diabetes of longer duration and was still higher than that any other complication. These results suggest that this abnormality can occur earlier than other diabetic complications and is a common finding in diabetic patients.<BR>Decrease in systolic blood pressure in the orthostatic position and ΔHR were studied in selected cases. A significant negative correlation was observed between them and there weresome patients with low ΔHR without significant fall in blood pressure after standing. The decrease in ΔHR was found to precede orthostatic hypotension.<BR>These results suggest that autonomic neuropathy is an early and common subclinical diabetic complication and the measurement of IFIR iq a noninvasive and useful method for its evaluation.

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  • 糖尿病

    糖尿病 26(1), 37-43, 1983

    一般社団法人 日本糖尿病学会

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