Effect Of Autonomic Neuropathy On Cerebrovascular Disease In Diabetic Mellitus

Objective: This study was designed to evaluate cerebral hemodynamic changes related to no diabetic automomic neuropathy(NO DAN)and diabetic autonomic neuropathy(DAN)patients with Transcranial Doppler ultrasonography(TCD)and analyzed the effect of autonomic neuropathy (AN)on cerebrovascular disease in diabetic mellitus(DM). Methods: There were 76 cases with type 2 diabetic patients who underwent 24h ambulatory ECG(Holter) monitoring for measurement of heart rate variability(HRV). Patients were divided into 2 groups according to SDNN,SDANN and rMSSD of HRV. The results showed that 35 NO DAN and 41 DAN patients. We measured the systolic peak flow velocity(Vp)and the pulsatility index(PI)of the middle cerebral artery (MCA), internal carotid artery (ICA), anterior cerebral artery (ACA), posterior cerebral artery(PCA), basilar artery(BA), vertebral artery(VA) and extracranial internal carotid artery (ICAext) in 76 patients with TCD. Variance between two groups was analyzed by SPSS 10.0 for windows. Results: 1, In each group, mean of most HRV index were decreased in diabetic patients.These changes in HRV were the most marked reduction in DAN group. 2, The mean of Vp and the rate of artery abnormality obtained from TCD were significantly higher in two groups than those in healthy controls, especially in DAN group.Most of the changes in Vp were increased speed,which were significantly higher in DAN group than those in NO DAN group. 3, Mean of PI in each cranial artery was significantly higher in two groups than those in healthy controls, especially in DAN group. 4, The rate of artery abnormality obtained from TCD and mean of PI were increased in DAN patients indicated that theoften in DAN patients.The range of vascular lesion in DAN patients wasmuch more extensive than NO DAN patients.Concludes:It is suggested that HRV can be used as a sensitive, simpleand quantitative indicator for the evaluation of DAN. In the DAN group,HRV is more markadly decreased compared with NO DAN group, andcerebrovascular disease is severity in DAN patients whose TCD showabnormality significantly. The DAN may be a risk factor in initiation andprogression of diabetic cerebrovascular disease.