Erbas T, Erbas B, Kabakci G, Aksöyek S, Koray Z, Gedik O
Hacettepe University, Medical School, Department of Endocrinology, Ankara, Turkey.
Clin Cardiol. 2000 Apr;23(4):259-63. doi: 10.1002/clc.4960230407.
The alteration of endothelin (ET) levels in diabetic patients with cardiac autonomic neuropathy (CAN) has not been studied extensively and its correlation with cardiac function parameters has not been discussed.
The aim of the present study was to discuss the correlation between the degree of cardiac autonomic neuropathy, plasma big-ET levels, and cardiac functions in diabetic patients who were clinically free of cardiovascular disease.
Twenty subjects (32.1 +/- 7.8 years, 11 men, 9 women) with insulin-dependent diabetes mellitus (IDDM) were studied to evaluate the relationship between circulating big-endothelin (big-ET1) levels, CAN, and cardiac functions. The severity of CAN was scored according to Ewing's criteria. Cardiac functions were assessed using Doppler echocardiography.
Left ventricular systolic function in the patient group was within normal limits and comparable with the values of the control group (n = 10). The mean E/A values of diabetics with CAN (1.15 +/- 0.33, p = 0.004) and without CAN (1.34 +/- 0.17) were significantly lower than those of controls (1.57 +/- 0.27). Diabetics with CAN had significantly higher big-ET1 values (81.1 +/- 94 pg/ml) compared with others (12.4 +/- 5.9 and 21.1 +/- 17.7 pg/ml, p = 0.04). Circulating big-ET1 levels showed a significant correlation with E/A values in the control group (p = 0.01, r = -0.7) and with peak A values (p = 0.003, r = 0.64) in diabetics. The CAN score correlated negatively with E/A values (p = 0.01, r = 0.54).
High big-ET levels might have an important role in the pathogenesis or consequences of diastolic dysfunction in diabetics with CAN. Their role in cardiac autonomic neuropathy and diastolic dysfunction should be investigated further.
糖尿病合并心脏自主神经病变（CAN）患者体内内皮素（ET）水平的变化尚未得到广泛研究，且其与心功能参数的相关性也未被探讨。
本研究旨在探讨临床无心血管疾病的糖尿病患者心脏自主神经病变程度、血浆大内皮素（big-ET）水平与心功能之间的相关性。
对20名胰岛素依赖型糖尿病（IDDM）患者（年龄32.1±7.8岁，男性11名，女性9名）进行研究，以评估循环大内皮素（big-ET1）水平、CAN与心功能之间的关系。根据尤因标准对CAN的严重程度进行评分。使用多普勒超声心动图评估心功能。
患者组左心室收缩功能在正常范围内，与对照组（n = 10）的值相当。合并CAN的糖尿病患者（1.15±0.33，p = 0.004）和未合并CAN的糖尿病患者（1.34±0.17）的平均E/A值显著低于对照组（1.57±0.27）。合并CAN的糖尿病患者的big-ET1值（81.1±94 pg/ml）显著高于其他患者（12.4±5.9和21.1±17.7 pg/ml，p = 0.04）。对照组中循环big-ET1水平与E/A值显著相关（p = 0.01，r = -0.7），糖尿病患者中与A峰峰值显著相关（p = 0.003，r = 0.64）。CAN评分与E/A值呈负相关（p = 0.01，r = 0.54）。
高big-ET水平可能在合并CAN的糖尿病患者舒张功能障碍的发病机制或后果中起重要作用。它们在心脏自主神经病变和舒张功能障碍中的作用应进一步研究。
