Chan Norman Nor, Vallance Patrick, Colhoun Helen Martina
EURODIAB, Department of Epidemiology, University College London, UK.
Arterioscler Thromb Vasc Biol. 2003 Jun 1;23(6):1048-54. doi: 10.1161/01.ATV.0000072968.00157.6B. Epub 2003 Apr 24.
Defective NO release/response may contribute to increased coronary risk and the loss of sex difference in coronary heart disease in diabetes. We aimed to determine whether NO release/response is impaired in type 1 diabetes and whether any defects are greater in women than men.
Forearm blood flow response to vasoactive drugs was assessed by venous plethysmography in 88 diabetic and 69 control subjects aged 30 to 53 years. In diabetic patients, response was 18% lower for acetylcholine (ACh) (P=0.002), 6% lower for bradykinin (P=0.14), and 17% lower for glyceryl trinitrate (GTN) (P<0.001). Women had a higher response to ACh than men (17%, P=0.006). The diabetes-associated defect in ACh was greater in women (25% lower, P=0.01) than men (13% lower, P=0.08), although not significantly (P=0.26 for the interaction). Poorer glycemic control was associated with ACh response (P=0.003) and contributed to the greater defect in diabetic women than men.
The diabetes-associated defect in GTN response was similar in men and women. Established coronary heart disease risk factors did not explain any of the defects in ACh or GTN response associated with diabetes. Type 1 diabetes is associated with impaired responsiveness to NO and with an impairment in ACh-stimulated NO release.
一氧化氮（NO）释放/反应缺陷可能会增加冠状动脉疾病风险，并导致糖尿病患者冠心病中性别差异的消失。我们旨在确定1型糖尿病患者的NO释放/反应是否受损，以及女性的任何缺陷是否比男性更严重。
采用静脉体积描记法评估了88例30至53岁糖尿病患者和69例对照者对血管活性药物的前臂血流反应。在糖尿病患者中，乙酰胆碱（ACh）反应降低了18%（P = 0.002），缓激肽反应降低了6%（P = 0.14），硝酸甘油（GTN）反应降低了17%（P < 0.001）。女性对ACh的反应高于男性（高17%，P = 0.006）。糖尿病相关的ACh缺陷在女性中（降低25%，P = 0.01）比男性中（降低13%，P = 0.08）更大，尽管差异无统计学意义（交互作用P = 0.26）。血糖控制较差与ACh反应相关（P = 0.003），并且导致糖尿病女性比男性有更大的缺陷。
GTN反应中与糖尿病相关的缺陷在男性和女性中相似。已确定的冠心病危险因素无法解释与糖尿病相关的ACh或GTN反应中的任何缺陷。1型糖尿病与对NO的反应受损以及ACh刺激的NO释放受损有关。
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