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The Relationship between Cardiovascular Autonomic Dysfunction and Ocular Abnormality in Chinese T2DM 时间:2017-06-16 13:00 来源:未知作者:admin 点击: 次 Abstract:Objective. This study aims to explore the relationship between autonomic nerve dysfunction—assessed by cardiovascular autonomic neuropathy risk score (CAN-RS)—and ocular abnormality in Chinese type 2 diabetes mellitus (T2DM). Method. This is a cross-sectional study. A total of 335 subjects with T2DM were enrolled. The state of visual acuity, the lens, the vitreous, and the fundus were tested by professional ophthalmic instruments. The electrochemical skin conductance (ESC) of the hands and feet was measured by SUDOSCAN, from which a cardiovascular autonomic neuropathy risk score (CAN-RS) was calculated. Receiver operating characteristic (ROC) curves were drawn to evaluate the feasibility and accuracy of CAN-RS in diabetic oculopathy screening. Results. Abnormalities of the lens, vitreous, and fundus accounted for 7.8%, 5.1%, and 9.9%, respectively, in this study. The means of hands and feet ESC were higher than 60 μS, and CAN-RS was 33.1 ± 14.8%. In logistic regression analysis, CAN-RS was positively associated with lens (OR = 1.055, ) and vitreous (OR = 1.044, ) abnormality. The area under ROC to detect lens and vitreous abnormality was 0.713 and 0.725, respectively. Conclusion. CAN-RS, a cardiac autonomic nerve dysfunction index calculated by SUDOSCAN, may be a promising index for lens and vitreous abnormality screening in T2DM patients. Further studies are needed to confirm the conclusion.
1. Introduction
Diabetic oculopathy is one of common complications in diabetics. Nearly all of the oculopathies can occur in diabetics, including retinopathy, uveitis, cataract, vitreous opacity, glaucoma, and optic neuropathy [1]. The Chinese Diabetes Committee reported that the blindness rate in diabetics was 25-fold higher than that in nondiabetics. So it is important to detect and diagnose diabetic oculopathy early.
Autonomic neuropathy and microangiopathy usually develop in parallel in diabetic patients. Many studies have demonstrated that retinopathy is related to cardiac autonomic neuropathy (CAN) [2–4]. Diabetic retinopathy (DR) may be a strong predictor for CAN [5, 6]. Evidence has shown that the close association between CAN and retinopathy likely stems from changes in the vasomotor control of the small vessels [7]. In these studies, the diagnostic method for CAN mainly refers to cardiovascular autonomic reflex tests (CARTs) [8], which are cumbersome, time consuming, and require strict cooperation. As for DR, the principal tools are funduscope and fluorescein angiography, which require considerable professional skill and time. Under these conditions, it is difficult to screen non- or poorly compliant patients in daily clinical practice, especially in a resource-poor medical environment. It is supposed that there may be other relatively simple substitutes for CARTs such as heart rate variability, postural blood pressure changes, baroreflex sensitivity, and cardiac radionuclide imaging [9] as well as the exercise-related heart rate changes [10, 11], and the relationship between these alternative methods and diabetic oculopathy should be verified further.
Damage to small nerve fibers may develop in the early course of diabetes and can be assessed by sudomotor function testing [10]. SUDOSCAN (Impeto Medical, France) is a recently developed sudomotor function test of the electrochemical skin conductance (ESC) of the hands and feet, which has been used widely in early diagnosis of symmetrical diabetic neuropathy [12, 13]. SUDOSCAN can also be used for the efficient screening of CAN by means of its proprietary cardiovascular autonomic neuropathy risk score (CAN-RS) [13–15], which is derived from ESC, HbA1c, age, and BMI. Many studies have been published which investigate the relationship between CAN-RS and diseases such as metabolic syndrome [16] and arterial stiffness [17], but its association with diabetic oculopathy remains unexplored. The previous studies usually focus mainly on DR in diabetic patients; however, other types of ocular abnormality are rarely investigated.
This study aims to examine the relationship between CAN-RS and diabetic oculopathy (including fundus lesion and other eye abnormalities) and to further explore whether CAN-RS can be used to screen for diabetic oculopathy.
2. Materials and Methods
2.1. Subject
Type 2 diabetes patients above 18 years of age were enrolled from the outpatient population in the People’s Liberation Army (PLA) Diabetes Diagnosis & Treatment Center. Exclusion criteria included patients with tumors, thyroid disease, immunological diseases, and autonomic nervous function disorders with pathogenies other than diabetes. Subjects with autonomic nerve function asymmetry and oculopathy caused by other pathogenesis were also excluded as well as subjects who were unable to cooperate with the inspectors, such as those with diabetic retinal hemorrhage, serious visual impairment, critical disease, and dementia. The study protocol was supported by The 306th Hospital of People’s Liberation Army and followed the guidelines of the Declaration of Helsinki. All the participants completed informed consent forms before the study.