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首页> 外文期刊>British journal of ophthalmology >Pupillary autonomic denervation with increasing duration of diabetes mellitus.
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Pupillary autonomic denervation with increasing duration of diabetes mellitus.

机译：瞳孔自主神经支配随着糖尿病持续时间的增加。

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BACKGROUND/AIMS: The autonomic pupillary changes in type I and II diabetic patients without clinical evidence of diabetic autonomic neuropathy (DAN) were compared with age matched controls. The relation between pupillary and cardiovascular autonomic function was assessed in the diabetic patients. METHODS: A case-control study was performed with diabetics grouped according to type and duration of diabetes. Static infrared pupillography was used to compare mean dark adapted pupil size and mean percentage changes in pupil size with pilocarpine 0.1% and cocaine 4% in the diabetic and control groups. All diabetic patients underwent cardiovascular autonomic function assessment using the Valsalva ratio, the 30:15 ratio, and testing for orthostatic hypotension. RESULTS: In total, 72 type I and 69 type II diabetic patients were compared with 120 controls. Mean dark adapted pupil size was significantly smaller in diabetic groups than controls. Except for type I diabetics with disease for less than 5 years, all patient groups had significantly greater mean percentage constriction in pupil size in response to dilute pilocarpine than controls. There was no significant difference between the mean percentage dilatation in response to cocaine 4% in diabetics and controls. A high proportion of patients had normal cardiovascular autonomic function particularly when this was assessed with the Valsalva ratio. CONCLUSIONS: Denervation hypersensitivity to dilute pilocarpine is a result of damage to the pupillary parasympathetic supply of diabetic patients. This occurs before the pupillary sympathetic pathway is affected, it can be detected early in the disease, and it may be a possible explanation for the small pupil size seen in diabetic patients. Pupillary autonomic dysfunction occurs before cardiovascular autonomic changes and detection of pupil denervation hypersensitivity to dilute pilocarpine is an inexpensive way to detect early DAN.
机译：背景/目的：将没有糖尿病自主神经病变（DAN）临床证据的I型和II型糖尿病患者的自主瞳孔变化与年龄匹配的对照组进行比较。在糖尿病患者中评估了瞳孔和心血管自主功能之间的关系。方法：根据糖尿病的类型和持续时间对糖尿病患者进行病例对照研究。静态红外瞳孔照相术用于比较糖尿病组和对照组的平均暗适应瞳孔尺寸和瞳孔尺寸的平均百分比变化，其中匹罗卡品0.1％和可卡因4％。所有的糖尿病患者均使用瓦尔瓦尔比（Valsalva），30：15的比率进行心血管自主功能评估，并测试体位性低血压。结果：总共将72例I型和69型II型糖尿病患者与120例对照进行了比较。在糖尿病组中，平均暗适应瞳孔尺寸明显小于对照组。除患有疾病的I型糖尿病患者不足5年外，所有患者组对毛果芸香碱稀释后的瞳孔平均收缩率均显着高于对照组。在糖尿病患者和对照组中，对4％可卡因的反应的平均扩张百分比之间没有显着差异。很大一部分患者的心血管自主神经功能正常，尤其是用瓦尔瓦尔比（Valsalva ratio）评估时。结论：神经肌肉对稀毛果芸香碱的超敏反应是糖尿病患者瞳孔副交感神经供应受损的结果。这发生在瞳孔交感途径受到影响之前，可以在疾病的早期发现，这可能是糖尿病患者中瞳孔缩小的可能原因。瞳孔自主神经功能障碍发生在心血管自主神经改变之前，检测瞳孔神经支配对稀释的毛果芸香碱超敏反应是检测早期DAN的廉价方法。

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