Neuropathie végétative diabétique: principes et méthodes d’exploration View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-09

AUTHORS

K. Hubeaux, X. Deffieux, P. Raibaut, D. Rogez, F. Lebreton, A. Marquer, G. Amarenco

ABSTRACT

La neuropathie végétative diabétique (NVD) a une prévalence de 30% dans le diabète, qu’il soit de type 1 ou 2. Il s’agit d’un facteur de risque de mortalité cardiovasculaire majeur. Les manifestations cliniques sont multiples, avec sur le plan cardiovasculaire une hypotension orthostatique, une tachycardie de repos, voire un infarctus silencieux du myocarde (IDM). Sur le plan digestif, une gastroparésie, des phénomènes de diarrhée et des troubles anorectaux sont fréquents; de même que des troubles vésicosphinctériens. Les méthodes d’évaluation de la NVD sont simples mais nécessitent des conditions techniques très strictes. Il s’agit de tests cardiovasculaires, évaluant la réponse tensionnelle ou de la fréquence cardiaque à des stimulations codifiées, permettant le diagnostic de neuropathie autonome cardiaque (NAC). Une batterie de quatre à cinq tests est recommandée pour le diagnostic de NVD. En première intention, la manœuvre de ventilation ample dirigée et le test de lever actif sont préconsiés. Si l’un de ces deux tests est perturbé, ou chez les patients à haut risque cardiovasculaire, il est préconisé de réaliser en plus un tilt test, une manœuvre de Valsalva et le test de contraction isométrique. Si un seul test est perturbé, une NAC précoce est suspectée; si deux tests sont perturbés, une NAC est confirmée. Ces tests doivent être répétés annuellement, afin de dépister et suivre une NAC. Une prise en charge thérapeutique optimale, sur le plan glycémique et des autres facteurs de risque cardiovasculaire, diminue le risque de survenue de NVD, et en cas de NVD, cette prise en charge réduit le risque de complications et de mortalité. More... »

PAGES

233-239

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11608-008-0204-y

DOI

http://dx.doi.org/10.1007/s11608-008-0204-y

DIMENSIONS

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