2型糖尿病合并心脏自主神经病变患者的主动脉扩张性降低。

Aortic distensibility is reduced in subjects with type 2 diabetes and cardiac autonomic neuropathy.

作者信息

Tentolouris N, Liatis S, Moyssakis I, Tsapogas P, Psallas M, Diakoumopoulou E, Voteas V, Katsilambros N

机构信息

Athens University Medical School, Laiko Hospital, Athens, Greece.

出版信息

Eur J Clin Invest. 2003 Dec;33(12):1075-83. doi: 10.1111/j.1365-2362.2003.01279.x.

DOI:10.1111/j.1365-2362.2003.01279.x

PMID:14636290

Abstract

BACKGROUND

Reduced aortic distensibility predicts cardiovascular mortality in patients with type 2 diabetes and impaired glucose tolerance. Cardiac autonomic neuropathy is common in subjects with diabetes. However, the relationship between the elastic properties of the aorta and autonomic neuropathy has not been studied to date in subjects with type 2 diabetes.

MATERIALS AND METHODS

In this cross-sectional study, a total of 87 subjects with type 2 diabetes (27 with and 60 without cardiac autonomic neuropathy) as well as 60 healthy individuals, matched for age and sex with the diabetic subjects, were examined. Cardiac autonomic neuropathy was diagnosed on the basis of the battery of the classic cardiovascular autonomic function tests. Aortic distensibility was assessed by high-resolution ultrasonography.

RESULTS

Diabetic patients had reduced aortic distensibility in comparison with the control subjects: 1.81 +/- 0.58 vs. 2.53 +/- 0.34 10-6 cm2 dyn-1, respectively (P < 0.0001). In addition, diabetic individuals with cardiac autonomic neuropathy had reduced aortic distensibility as compared with patients without this complication: 1.60 +/- 0.72 vs. 1.90 +/- 0.48 10-6 cm2 dyn-1, respectively (P = 0.02). Multivariate linear regression analysis in the diabetic group, after controlling for a number of confounding factors such as age, systolic and diastolic blood pressure, duration of diabetes and presence as well as severity of cardiac autonomic neuropathy, demonstrated a significant and independent association between duration of diabetes [B = -0.02, SE(B) = 0.01, P = 0.01] and presence of cardiac autonomic neuropathy [B = -0.29, SE(B) = 0.14, P = 0.03] with aortic distensibility.

CONCLUSION

Type 2 diabetes is associated with a significant reduction in the elastic properties of the aorta. In addition, known duration of diabetes and presence of cardiac autonomic neuropathy are the main predictors of aortic distensibility in subjects with type 2 diabetes.

摘要

背景

主动脉扩张性降低可预测2型糖尿病和糖耐量受损患者的心血管死亡率。心脏自主神经病变在糖尿病患者中很常见。然而，迄今为止，尚未在2型糖尿病患者中研究主动脉弹性特性与自主神经病变之间的关系。

材料与方法

在这项横断面研究中，共检查了87名2型糖尿病患者（27名有心脏自主神经病变，60名无心脏自主神经病变）以及60名年龄和性别与糖尿病患者相匹配的健康个体。根据一系列经典的心血管自主功能测试诊断心脏自主神经病变。通过高分辨率超声评估主动脉扩张性。

结果

与对照组相比，糖尿病患者的主动脉扩张性降低：分别为1.81±0.58与2.53±0.34×10⁻⁶ cm² dyn⁻¹（P<0.0001）。此外，与无此并发症的患者相比，患有心脏自主神经病变的糖尿病个体的主动脉扩张性降低：分别为1.60±0.72与1.90±0.48×10⁻⁶ cm² dyn⁻¹（P = 0.02）。在糖尿病组中进行多变量线性回归分析，在控制了年龄、收缩压和舒张压、糖尿病病程以及心脏自主神经病变的存在和严重程度等多个混杂因素后，结果显示糖尿病病程[B = -0.02，SE(B)=0.01，P = 0.01]和心脏自主神经病变的存在[B = -0.29，SE(B)=0.14，P = 0.03]与主动脉扩张性之间存在显著且独立的关联。