Mäkimattila Sari, Yki-Järvinen Hannele
University of Helsinki, Department of Medicine, Division of Diabetes, P.O. Box 340, Helsinki, 00029 HUCH, Finland.
Curr Diab Rep. 2002 Feb;2(1):26-36. doi: 10.1007/s11892-002-0054-x.
In nondiabetic individuals, a poor response to an endothelium-dependent vasodilator in coronary vessels has been shown to increase the likelihood of a future cardiovascular event. Such prospective data are not as yet available in patients with type 1 or type 2 diabetes. However, consistent with the greatly increased cardiovascular risk in these patients, endothelial dysfunction has been almost universally found to characterize patients with type 2 diabetes particularly. Endothelial dysfunction frequently coexists with features of insulin resistance, such as the presence of small dense low-density lipoprotein (LDL) particles even in nondiabetic individuals. This association is independent of obesity and other causes of endothelial dysfunction, such as LDL cholesterol, hypertension, and smoking. In patients with type 1 diabetes, endothelial dysfunction has been found in approximately half of the studies. In some but not all studies, endothelial dysfunction has been especially severe in patients with poor glycemic control. Reversal or amelioration of endothelial dysfunction has been documented by many commonly used therapeutic agents such as successful insulin therapy, fibrates, and angiotensin-converting enzyme inhibitors, but also with some but not all agents that act as antioxidants. Long-term studies addressing the prognostic significance of endothelial dysfunction and its reversal are urgently needed to determine whether measurement of endothelial function could be used to identify individuals at risk better than can be done at present using classic risk factor assessment among patients with type 2 diabetes especially.
在非糖尿病个体中，冠状动脉血管对内皮依赖性血管舒张剂反应不佳已被证明会增加未来发生心血管事件的可能性。1型或2型糖尿病患者目前尚无此类前瞻性数据。然而，与这些患者心血管风险大幅增加相一致的是，内皮功能障碍几乎在所有2型糖尿病患者中均有发现。内皮功能障碍常与胰岛素抵抗特征并存，比如即使在非糖尿病个体中也存在小而密的低密度脂蛋白（LDL）颗粒。这种关联独立于肥胖及其他导致内皮功能障碍的因素，如LDL胆固醇、高血压和吸烟。在1型糖尿病患者中，约半数研究发现存在内皮功能障碍。在一些但并非所有研究中，血糖控制不佳的患者内皮功能障碍尤其严重。许多常用治疗药物，如成功的胰岛素治疗、贝特类药物和血管紧张素转换酶抑制剂，以及一些但并非所有具有抗氧化作用的药物，都已证明可逆转或改善内皮功能障碍。迫切需要开展长期研究，以探讨内皮功能障碍及其逆转的预后意义，从而确定在2型糖尿病患者中，测量内皮功能是否比目前使用经典危险因素评估能更好地识别高危个体。
