隨著糖尿病盛行率的逐年增加,且若併發心血管自主神經病變會提高其死亡率及增加猝死的危險,因此糖尿病併發自主神經功能障礙是個值得重視的課題。諸多學者都認同自主神經系統除了依內在的需要而自行調整外,也接受中樞神經系統的調控,但自主神經與中樞神經的互動模式和涉及中樞神經參與的部分,至今仍眾說紛紜。腦電圖與心率變異的整合分析,為探討中樞神經與自主神經功能相關性研究的良好工具。 為釐清中樞神經參與自主神經調控的模式與部位,本研究共收集44位自主神經功能障礙的第2型糖尿病患者與24位正常控制組,評估其自主神經功能並同步記錄腦電圖及心電圖。以標準化頻譜的分析獲得方均根植(RMSSD)、標準化低頻(LFnu)、標準化高頻(HFnu)、低頻對高頻的比值(LF/HF)等心率變異指標,且依腦電圖的頻率,取得α、β、θ及δ波之比例,分析比較糖尿病患者與控制組心血管自主神經功能、心率變異各項指標與腦電圖各波段之差異及相關性。結果顯示糖尿病患者的正常呼吸與深呼吸時的心跳間隔變異數和姿勢改變之血壓變動均與控制組有顯著差異,其心率變異RMSSD、LFnu及LF/HF等指標也都顯著低於正常控制組,意味著併發自主神經功能障礙之糖尿病患者其自主神經調節心率的功能顯著減弱,交感及副交感神經之互動失衡,且以交感神經功能障礙較為顯著。综合心率和腦電圖的差異與相關性,大腦之額葉,尤其是前額葉部位,與自主神經功能的調節有關聯,確立了前額葉在自主神經調控扮演某種程度的角色。
The diabetic autonomic neuropathy is a serious emerging issue with the increasing of prevalence in diabetes. When cardiovascular autonomic neuropathy occurs, it carries poor prognosis and increases the risk of sudden death. Autonomic system can be autoregulated by itself and may be coordinated by central nervous system. However, it remains controversial on the mode of interaction between central nervous system and autonomic nervous system. In recent years, the integrative analysis of electroencephalography (EEG) and heart rate variability (HRV) have offered the excellent instrumentional tools to study the interaction between cerebral cortical and autonomic functions. Based on autonomic function evaluation, we recruited normal controls and type 2 diabetic patients with autonomic neuropathy to explore whether central nervous system is related to autonomic control. Simultaneous EEG and cardiac recordings were performed. HRV indexes included RMSSD, LFnu, HFnu and LF/HF ratio and α, β, θ, δ waves were estimated by normalized power spectral analysis. We analyzed the relationship between indexes of HRV and α, β, θ, δ wave activities in different brain lobes. Our results showed the apparent impairment of autonomic function and decreased RMSSD, LFnu, and LF/HF ratio in diabetic patients with autonomic neuropathy compared to control subjects, particularly in sympathetic nerve function and sympathovagal balance. The assessment between EEG and HRV showed prefrontal cortex involvement in autonomic control. Such a paradigm could be applied in the management and detection of autonomic nerve function impairment in the future.