Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular compli...Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control.The entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory cytokines.This microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden death.It has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease development.However,CAN might be subclinical for several years,and a late diagnosis increases the mortality risk.The duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor prognosis.Several tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial scintigraphy.Currently,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating cost.Therefore,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.展开更多
顽固性高血压,往往合并心脑肾等靶器官的损害,是发生心血管事件的高危人群。研究已经证实交感神经的兴奋性程度与患者的血压水平呈正相关。20世纪50年代报道,外科去交感神经术用于高血压治疗,实施内脏神经、内脏交感神经切除术的效果和...顽固性高血压,往往合并心脑肾等靶器官的损害,是发生心血管事件的高危人群。研究已经证实交感神经的兴奋性程度与患者的血压水平呈正相关。20世纪50年代报道,外科去交感神经术用于高血压治疗,实施内脏神经、内脏交感神经切除术的效果和安全性未得到认可。20世纪70年代许多学者在不同实验高血压模型(遗传性、盐敏感性、肥胖型、肾动脉性高血压)上探索肾交感神经阻断方法,证实肾交感神经与高血压密切相关。2007年报道经皮导管肾脏交感神经消融术,选择性阻断肾脏交感神经,术后1、3、6、12个月血压分别下降14/10、22/11、22/10、26/11 mm Hg,治疗未发生消融相关严重并发症。随后的研究进一步证实其临床效果。经导管肾交感神经消融在顽固性高血压治疗的有效性和安全性得到初步确定。展开更多
文摘Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control.The entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory cytokines.This microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden death.It has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease development.However,CAN might be subclinical for several years,and a late diagnosis increases the mortality risk.The duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor prognosis.Several tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial scintigraphy.Currently,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating cost.Therefore,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.
文摘顽固性高血压,往往合并心脑肾等靶器官的损害,是发生心血管事件的高危人群。研究已经证实交感神经的兴奋性程度与患者的血压水平呈正相关。20世纪50年代报道,外科去交感神经术用于高血压治疗,实施内脏神经、内脏交感神经切除术的效果和安全性未得到认可。20世纪70年代许多学者在不同实验高血压模型(遗传性、盐敏感性、肥胖型、肾动脉性高血压)上探索肾交感神经阻断方法,证实肾交感神经与高血压密切相关。2007年报道经皮导管肾脏交感神经消融术,选择性阻断肾脏交感神经,术后1、3、6、12个月血压分别下降14/10、22/11、22/10、26/11 mm Hg,治疗未发生消融相关严重并发症。随后的研究进一步证实其临床效果。经导管肾交感神经消融在顽固性高血压治疗的有效性和安全性得到初步确定。
