Giannattasio C, Failla M, Grappiolo A, Gamba P L, Paleari F, Mancia G
Internal Medicine, Università of Milan-Bicocca, S.Gerardo Hospital, Monza, Milano, Italy.
Diabetologia. 2001 Feb;44(2):203-8. doi: 10.1007/s001250051600.
AIMS/HYPOTHESIS: Type I (insulin-dependent) diabetes mellitus is accompanied by reduced arterial distensibility and increased arterial wall thickness even in normotensive subjects with no micro-macrovascular complications. It is not known whether, and how fast, these subclinical markers of vascular damage develop over time.
We measured arterial wall distensibility in radial, common carotid artery and abdominal aorta in 60 normotensive patients (aged 35.0 +/- 1.2 years, means +/- SE) with Type I diabetes with no microvascular or macrovascular complications and in 20 healthy control subjects matched for age. Arterial distensibility was determined by continuous measurements of arterial diameter through echotracking techniques and by using either the Langewouters (radial artery) or the Reneman formula (carotid artery and aorta). The same echotracking techniques allowed us to ascertain the radial and carotid artery wall thickness. Data were collected before and after 23 +/- 1 months.
In the first study, carotid artery distensibility was similar but radial artey and aortic distensibility was less (p < 0.01) in patients with diabetes than in control subjects (-39 % and 25 % respectively). This was accompanied by an increase (p < 0.01) in both radial (42 %) and carotid artery wall thickness (46 %). After 23 +/- 1 months diabetic subjects showed a further reduction in arterial distensibility (radial-12 %, p < 0.05; carotid-8 %, NS; aorta-20% p < 0.05) and an increase in arterial wall thickness (radial + 15 %; carotid 14%, p < 0,05). No change in distensibility and wall thickness values occurred in control subjects.
CONCLUSION/INTERPRETATION: The early reduction in arterial distensibility and increase in arterial wall thickness characterizing uncomplicated normotensive Type I diabetes patients shows a measurable worsening over the short term.
目的/假设：即使在没有微血管和大血管并发症的血压正常的受试者中，I型（胰岛素依赖型）糖尿病也伴有动脉扩张性降低和动脉壁厚度增加。目前尚不清楚这些血管损伤的亚临床标志物是否会随着时间推移而出现，以及发展速度有多快。
我们测量了60名无微血管或大血管并发症的I型糖尿病血压正常患者（年龄35.0±1.2岁，均值±标准误）以及20名年龄匹配的健康对照者的桡动脉、颈总动脉和腹主动脉的动脉壁扩张性。通过回声跟踪技术连续测量动脉直径，并使用Langewouters公式（桡动脉）或Reneman公式（颈动脉和主动脉）来确定动脉扩张性。相同的回声跟踪技术使我们能够确定桡动脉和颈动脉壁厚度。在23±1个月前后收集数据。
在第一项研究中，糖尿病患者的颈动脉扩张性相似，但桡动脉和主动脉扩张性低于对照组（分别降低39%和25%，p<0.01）。同时，桡动脉（增加42%）和颈动脉壁厚度（增加46%）均增加（p<0.01）。23±1个月后，糖尿病患者的动脉扩张性进一步降低（桡动脉降低12%，p<0.05；颈动脉降低8%，无统计学意义；主动脉降低20%，p<0.05），动脉壁厚度增加（桡动脉增加15%；颈动脉增加14%，p<0.05）。对照组的扩张性和壁厚度值没有变化。
结论/解读：无并发症的血压正常的I型糖尿病患者早期出现的动脉扩张性降低和动脉壁厚度增加在短期内有明显恶化。
