Chest
Volume 121, Issue 2, February 2002, Pages 443-451
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Clinical Investigations
Neuromuscular Disease
Neuroadrenergic Denervation of the Lung in Type I Diabetes Mellitus Complicated by Autonomic Neuropathy

https://doi.org/10.1378/chest.121.2.443Get rights and content

Study objective

To verify whether autonomic neuropathy (AN) complicating type I, insulin-dependent diabetes mellitus affected neuroadrenergic bronchopulmonary innervation.

Patients

Twenty nonsmoking diabetic patients without respiratory diseases were studied: 11 patients with AN (group AN) and 9 patients without AN (control; group C) diagnosed by standardized criteria.

Design

Patients underwent respiratory function tests and ventilatory scintigraphies with 123I-metaiodobenzylguanidine (MIBG) and with 99mTc-diethylenetriaminepenta-acetic acid (DTPA) to assess both bronchopulmonary neuroadrenergic innervation and also permeability of the alveolar-capillary barrier to water-soluble tracers. Rates of pulmonary clearance of the two tracers were computed, and correlates were identified by nonparametric statistics.

Setting

University hospital.

Results

The AN and C groups had normal respiratory function test results and comparable duration of diabetes and quality of metabolic control. 99mTc-DTPA clearance did not distinguish the groups. 123I-MIBG clearance was faster in the AN group than in the C group (mean ± SD half-time of the radiotracer time-activity curve [T1/2], 116.1 ± 22.8 min in the AN group vs 139.5 ± 18.3 min in the C group, p = 0.022), which is consistent with neuroadrenergic denervation in the AN group. 123I-MIBG clearance was independent from 99mTc-DTPA clearance. Faster 123I-MIBG clearance was significantly associated with worse performance in three of the four autonomic tests.

Conclusions

Neuroadrenergic bronchopulmonary denervation may occur in diabetic patients with AN despite normal clinical and respiratory function findings. Further research is needed to identify clinical and prognostic implications of these findings.

Section snippets

Subjects

Twenty patients with type I diabetes mellitus (9 male, 11 female; mean ± SD age, 44.30 ± 9.86 years) diagnosed according to standardized criteria were studied.13 AN was diagnosed in 11 patients (AN group), and 9 patients did not have AN and were considered control patients (C group). AN was diagnosed according to a standardized procedure including four cardiovascular autonomic tests (Table 1). Normal, borderline, and abnormal responses to each maneuver of autonomic stimulation are reported in

Results

Table 2 shows demographic, clinical, and respiratory function data of the patients. Both groups had comparable and normal lung volumes and bronchial reactivity to methacholine. Three AN group patients but no C group patients had abnormal Dlco values. The quality of the metabolic control, as expressed by GHb, did not distinguish groups. Prevalence of proteinuria (> 3.5 mg/dL) and of diabetic retinopathy were significantly and tendentially higher in the AN group.

Table 3 shows the results of

Discussion

The present study demonstrates that loss of neuroadrenergic innervation of the lung might be a feature of AN complicating type I diabetes mellitus. The lack of correlation between alveolar permeability to water-soluble tracers and 123I-MIBG clearance guarantees that present findings really reflect neuroadrenergic denervation. The strong parallelism between the severity of AN, expressed by standardized indexes, and lung neuroadrenergic denervation further supports this conclusion. However,

ACKNOWLEDGMENT

This article is dedicated to Dr. Patrizia Cotroneo.

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