العلاقة بين اعتلال الجهاز العصبي اللاارادي الناتج عن السكري مع مستوى اللبتين وامراض القلب حسب فحص ايكو القلب وفحص اجهاد القلب == Relation of Diabetic Autonomic Neuropathy With Leptin And Cardiac Disease Assessed By Echo And Treadmill Test
Author name:
زينب فلاح حسن
Supervisor name:
احسان محمد عبود عجينة | علاء حسين عباس
General topic:
Medicine
Specific topic:
Physiology
Degree:
Doctorate
University:
University of Kufa - Faculty Of Medicine - Department Of Physiology And Medical Physics
Language:
English
University location:
Najaf
First pages:
19T1099 - p.pdf
Abstract:
الخلفية : الاعتلال العصبي اللاارادي القلبي له تاثير سلبي على الحياة ونوعيتها للاشخاص المصابين بالسكري. الاعتلال العصبي اللاارادي القلبي يعتبر نوع فرعي من الاعتلال العصبي السكري. هذا النوع من الاعتلال هو الاكثر بروزا لتهديده للحياة وبسبب توفر الفحص القلبي | Background : Cardiac autonomic neuropathy (CAN) has a negative effect on survival and quality of life in people with diabetes mellitus (DM) and is regarded as a subtype of the diabetic autonomic neuropathy. This type of neuropathy is the most prominent focusing because of its life threatening and the availability of the cardiovascular tests that can diagnose it. It has been thought that many factors in DM like leptin causing increase the risk of cardiovascular disease. Researches about the relation of leptin with CAN and cardiovascular disease are yet limited.Aim of study : This study aims to determine the prevalence of CAN in patients with type 2 diabetes mellitus, evaluate the association between CAN the presence of left ventricular dysfunction in these patients, test the association between CAN and ischemic heart disease and assess the relationship between the presence and severity of CAN with fasting serum leptin in these patients.Patients, materials and methods : This cross sectional study included 103 (56 males and 47 females) diabetic patients without hypertension or pre - diagnosis of ischemia. They had attended to the diabetic center in Marjan Medical City in Hilla from March 2013 to February 2014. The patients had undergone thorough assessments that included clinical (history and full examination) and biochemical assessments (measurement of fasting plasma sugar, glycated haemoglobin, lipid profile, blood urea, serum creatinine and serum leptin level). Cardiac autonomic reflex tests were also assessed along with echocardiography and treadmill test. Cardiac autonomic reflex tests included the five tests of Ewing protocol. Patients who had two or more abnormal tests were considered as having CAN (75 patients) and those with less than two abnormal tests were considered as patients without CAN (28 patients). Results : The study found that most diabetic patients (84%) were obese (BMI?25 kg/m2) and most of the diabetic patients presented with CAN (72.8%). Fasting serum leptin level was higher in female than in male in both study groups (with and without CAN). Patients with CAN were older when compared to patients without CAN (p?0.01) and had longer duration of DM (p?0.01) with significantly higher fasting serum leptin levels. The leptin level showed a tendency to increase as the score of CAN increased. However, these changes were not significant (P>0.05). The most abnormal sympathetic response was diastolic blood pressure response to hand grip while the most abnormal parasympathetic response was heart rate response to breathing. On contrary, the lowest abnormal response was found in postural blood pressure test. Echocardiography showed that most of the diabetic patients (89.8%) had a left ventricular hypertrophy by measuring the left ventricular mass index. However, there were no significant changes in echocardiographic results between patients with CAN and those without.Conclusions : This study concludes that CAN is a common complication of type 2 diabetes that affected a large percentage of diabetic patients. The duration of the diabetes and the age of patients are important non modifiable risk factors for the development of CAN. Additionally, heart rate variability is considered as an important test for early detection of CAN. On the other hand, CAN has no impact on the occurrence of left ventricular diastolic dysfunction. Leptin level was high in diabetic patients and even higher in those with CAN and its levels related positively with the severity of CAN. Also, there were high leptin levels in diabetic patients with positive treadmill test results, although these changes were not significant (P>0.05).
