肾胰联合移植后，尿毒症1型糖尿病患者肾血管系统对L-精氨酸诱导的血管舒张作用得以保留，但单纯肾移植后则不然。

L-arginine-induced vasodilation of the renal vasculature is preserved in uremic type 1 diabetic patients after kidney and pancreas but not after kidney-alone transplantation.

作者信息

De Cobelli Francesco, Fiorina Paolo, Perseghin Gianluca, Magnone Marta, Venturini Massimo, Zerbini Gianpaolo, Zanello Alessandro, Mazzolari Gabriella, Monti Lucilla, Di Carlo Valerio, Secchi Antonio, Del Maschio Alessandro

机构信息

Department of Radiology, Università Vita e Salute-San Raffaele, San Raffaele Scientific Institute, Milan, Italy.

出版信息

Diabetes Care. 2004 Apr;27(4):947-54. doi: 10.2337/diacare.27.4.947.

DOI:10.2337/diacare.27.4.947

PMID:15047654

Abstract

OBJECTIVE

In uremic type 1 diabetic patients, kidney and pancreas transplantation (KP) and kidney-alone transplantation (KD) provide full restoration of normal renal function; however, only KP, i.e., curing diabetes, is expected to prevent endothelial damages. Our aim was to study L-arginine-induced vasodilation of the renal vasculature in uremic type 1 diabetic patients after KP or KD using magnetic resonance (MR).

RESEARCH DESIGN AND METHODS

MR quantitative flow measurements were performed in 15 KP patients (mean age 39.0 +/- 1.7 years, 10 men and 5 women), in 11 KD patients (mean age 47.3 +/- 1.9 years, 7 men and 4 women), and in 8 nondiabetic kidney transplant patients (mean age 44.0 +/- 4.8 years, 7 men and 1 woman), who were used as control subjects, to measure renal blood flow and velocity and renal vascular resistance before and immediately after infusion of L-arginine.

RESULTS

Renal blood flow and velocity were not different at baseline in KP, KD, and control subjects. In contrast, during L-arginine administration renal blood flow increased significantly in KP subjects (basal 8.4 +/- 0.6 vs. post 9.6 +/- 0.8 ml/s, Delta 14.3 +/- 4.4%, P < 0.05) and in control subjects (basal 9.3 +/- 0.8 vs. post 9.1 +/- 0.8 ml/s, Delta 17.3 +/- 6.2%, P < 0.01), while it remained unchanged in KD subjects (basal 10.0 +/- 0.8 vs. post 11.6 +/- 0.9 ml/s, Delta -1.36 +/- 6.9%, NS). Parallel results have been achieved for renal blood velocity (KP subjects: 20.1 +/- 4.9%, P < 0.01; control subjects: 23.0 +/- 7.99%, P < 0.01; and KD subjects: -0.3 +/- 6.5%; NS). A reduction in renal vascular resistance in response to L-arginine was evident in KP and control subjects but not in KD patients.

CONCLUSIONS

L-Arginine vasodilatory response was successfully assessed with MR quantitative flow measurements. KP patients and control subjects, but not those with KD, showed a preserved L-arginine-induced vasodilation of the renal vasculature.

摘要

目的

在尿毒症1型糖尿病患者中，肾胰联合移植（KP）和单纯肾移植（KD）均可使肾功能完全恢复正常；然而，只有KP（即治愈糖尿病）有望预防内皮损伤。我们的目的是使用磁共振（MR）研究尿毒症1型糖尿病患者在接受KP或KD后L-精氨酸诱导的肾血管舒张情况。

研究设计与方法

对15例KP患者（平均年龄39.0±1.7岁，10例男性和5例女性）、11例KD患者（平均年龄47.3±1.9岁，7例男性和4例女性）以及8例非糖尿病肾移植患者（平均年龄44.0±4.8岁，7例男性和1例女性，作为对照）进行MR定量血流测量，以测量输注L-精氨酸之前及之后即刻的肾血流量、流速和肾血管阻力。

结果

KP组、KD组和对照组在基线时肾血流量和流速无差异。相比之下，在给予L-精氨酸期间，KP组患者的肾血流量显著增加（基础值8.4±0.6 vs. 给药后9.6±0.8 ml/s，变化量14.3±4.4%，P<0.05），对照组患者也如此（基础值9.3±0.8 vs. 给药后9.1±0.8 ml/s，变化量17.3±6.2%，P<0.01），而KD组患者的肾血流量保持不变（基础值10.0±0.8 vs. 给药后11.6±0.9 ml/s，变化量-1.36±6.9%，无统计学意义）。肾血流速度也得到了类似结果（KP组患者：20.1±4.9%，P<0.01；对照组患者：23.0±7.99%，P<0.01；KD组患者：-0.3±6.5%；无统计学意义）。KP组和对照组患者在给予L-精氨酸后肾血管阻力降低，而KD组患者则未出现这种情况。