从机制到治疗：糖尿病自主神经病变

doi:10.12114/j.issn.1007-9572.2025.0335

中国全科医学 ›› 2026, Vol. 29 ›› Issue (21): 2982-2988.DOI: 10.12114/j.issn.1007-9572.2025.0335

所属专题：内分泌代谢性疾病最新文章合辑；神经/行为/心理最新文章合辑

• 论著·专病研究·糖尿病 • 上一篇下一篇

从机制到治疗：糖尿病自主神经病变

潘茈云¹^,², 殷豪³, 林至柔¹, 毛靖仪¹, 黄艳¹, 罗艳华¹, 肖家福¹, 胡阴¹^,^*()

1．421001　湖南省衡阳市，南华大学附属第一医院内分泌代谢科
2．421001　湖南省衡阳市，南华大学附属第一医院检验科
3．421001　湖南省衡阳市，南华大学附属第一医院康复医学科

收稿日期:2025-04-10 修回日期:2025-11-20 出版日期:2026-07-20 发布日期:2026-06-03
通讯作者: 胡阴
作者贡献：
潘茈云、殷豪负责文章的构思与设计、论文撰写；林至柔、毛靖仪、黄艳、罗艳华、肖家福负责论文修订、文章质量控制及审校；胡阴负责论文指导、文章修改与审阅。
基金资助:
国家自然科学基金资助项目(82000845); 湖南省自然科学基金资助项目(2021JJ40492); 湖南省教育厅科学研究项目(24A0311); 湖南省社科成果评审委员会项目(XSP22YBC361)

From Mechanism to Therapy: Diabetic Autonomic Neuropathy

PAN Ziyun¹^,², YIN Hao³, LIN Zhirou¹, MAO Jingyi¹, HUANG Yan¹, LUO Yanhua¹, XIAO Jiafu¹, HU Yin¹^,^*()

1. Department of Metabolism and Endocrinology, the First Affiliated Hospital, University of South China, Hengyang 421001, China
2. Department of Laboratory Medicine, the First Affiliated Hospital, University of South China, Hengyang 421001, China
3. Department of Rehabilitation Medicine, the First Affiliated Hospital, University of South China, Hengyang 421001, China

Received:2025-04-10 Revised:2025-11-20 Published:2026-07-20 Online:2026-06-03
Contact: HU Yin

摘要/Abstract

摘要： 糖尿病神经病变（DN）是糖尿病最常见且最具破坏性的慢性并发症，其中自主神经病变因累及多器官系统功能而备受关注。高血糖引发的代谢异常、氧化应激与微血管病变等病理机制可导致自主神经功能紊乱，引发静息心动过速、胃轻瘫、膀胱功能障碍等临床症状。在糖尿病自主神经病变（DAN）治疗方面，优化血糖控制为基础，同时结合醛糖还原酶抑制剂、抗氧化剂及神经营养药物协同缓解临床症状。此外通过利用神经调控技术以及实施个体化干预，可实现对系统性损伤的靶向调节。该文就DAN的病理生理机制、多组织器官的临床表现以及基于自主神经系统调控的治疗策略进行综述，旨在为深入解析DN病理机制及优化临床干预策略提供理论基础。

关键词: 糖尿病, 自主神经系统疾病, 调控机制, 诊断, 治疗策略

Abstract:

Diabetic neuropathy (DN) is a common and serious long-term complication of diabetes, with autonomic neuropathy gaining considerable attention due to its effects on various organ systems. The dysfunction of autonomic nerves is caused by pathological mechanisms such as metabolic imbalances, oxidative stress, and microvascular damage due to high blood sugar levels, leading to clinical symptoms like resting tachycardia, delayed stomach emptying, and bladder issues. The management of diabetic autonomic neuropathy (DAN) involves a foundational approach of stringent glycemic control, complemented by a combination of aldose reductase inhibitors, antioxidants, and neurotrophic agents to synergistically alleviate clinical symptoms. Furthermore, the utilization of neuromodulation techniques and the implementation of personalized treatments enable targeted modulation of the systemic impairments. This article provides a comprehensive review of the pathophysiological mechanisms of DAN, its clinical manifestations across multiple tissues and organs, and treatment strategies based on autonomic nervous system regulation, aiming to establish a theoretical foundation for in-depth analysis of DN pathological mechanisms and optimization of clinical intervention approaches.

Key words: Diabetes mellitus, Autonomic nervous system diseases, Regulation mechanism, Diagnosis, Therapeutic strategies

中图分类号:

R 587.1

潘茈云,殷豪,林至柔,等. 从机制到治疗：糖尿病自主神经病变[J]. 中国全科医学, 2026, 29(21): 2982-2988. DOI: 10.12114/j.issn.1007-9572.2025.0335.
PAN Ziyun,YIN Hao,LIN Zhirou, et al. From Mechanism to Therapy: Diabetic Autonomic Neuropathy[J]. Chinese General Practice, 2026, 29(21): 2982-2988. DOI: 10.12114/j.issn.1007-9572.2025.0335.

图/表 3

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神经病变	临床表现	筛查与诊断方法
心血管自主神经病变	心悸、头晕、虚弱无力、视力障碍、晕厥、直立性低血压、静息心动过速、HRV下降	卧立位血压试验：收缩压降低≥20 mmHg（1 mmHg=0.133 kPa）、24 h动态血压监测、静息心率检测、HRV的检测（深呼吸HRV、卧立位HRV、Valsalva动作HRV）
胃肠道自主神经病变	食管动力障碍、胃食管反流、胃轻瘫、腹泻、大便失禁、便秘	胃排空核素显像检查、胃电图、胃排空呼气试验、无线动力胶囊、上消化道内镜、食管24 h动态pH值监测
泌尿生殖系统自主神经病变	膀胱功能障碍：夜尿、尿频、尿急、尿潴留、尿道感染性功能障碍：男性表现为勃起功能障碍或逆行射精，女性表现为性欲降低、阴道润滑不良	超声检查、全面尿流动力学检查、膀胱功能评估性激素水平测定，男性：评估夜间阴茎肿胀、阴茎-球海绵体反射、阴茎背侧感觉神经传导、阴茎多普勒超声、阴茎交感皮肤反应；女性：会阴部感觉检查
皮肤和周围系统	泌汗功能障碍：多汗症或无汗症	皮肤交感反应、定量泌汗轴突反射、电化学皮肤电导、热调节发汗试验
无症状低血糖	低血糖无感知功能	血糖监测、低血糖感知问卷
瞳孔功能异常	水平瞳孔直径减小、瞳孔大小不均等、可卡因与磷脂酰胆碱反应减弱	对光反射、裂隙灯检查、瞳孔测量法、低浓度毛果芸香碱试验

神经病变	临床表现	筛查与诊断方法
心血管自主神经病变	心悸、头晕、虚弱无力、视力障碍、晕厥、直立性低血压、静息心动过速、HRV下降	卧立位血压试验：收缩压降低≥20 mmHg（1 mmHg=0.133 kPa）、24 h动态血压监测、静息心率检测、HRV的检测（深呼吸HRV、卧立位HRV、Valsalva动作HRV）
胃肠道自主神经病变	食管动力障碍、胃食管反流、胃轻瘫、腹泻、大便失禁、便秘	胃排空核素显像检查、胃电图、胃排空呼气试验、无线动力胶囊、上消化道内镜、食管24 h动态pH值监测
泌尿生殖系统自主神经病变	膀胱功能障碍：夜尿、尿频、尿急、尿潴留、尿道感染性功能障碍：男性表现为勃起功能障碍或逆行射精，女性表现为性欲降低、阴道润滑不良	超声检查、全面尿流动力学检查、膀胱功能评估性激素水平测定，男性：评估夜间阴茎肿胀、阴茎-球海绵体反射、阴茎背侧感觉神经传导、阴茎多普勒超声、阴茎交感皮肤反应；女性：会阴部感觉检查
皮肤和周围系统	泌汗功能障碍：多汗症或无汗症	皮肤交感反应、定量泌汗轴突反射、电化学皮肤电导、热调节发汗试验
无症状低血糖	低血糖无感知功能	血糖监测、低血糖感知问卷
瞳孔功能异常	水平瞳孔直径减小、瞳孔大小不均等、可卡因与磷脂酰胆碱反应减弱	对光反射、裂隙灯检查、瞳孔测量法、低浓度毛果芸香碱试验

从机制到治疗：糖尿病自主神经病变

From Mechanism to Therapy: Diabetic Autonomic Neuropathy

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