Demidova T Iu, Ametov A S, Smagina L V
Klin Med (Mosk). 2005;83(10):25-30.
The aim of the study was to evaluate the functional condition of the endothelium in patients with type II diabetes and arterial hypertension, depending on various metabolic factors. 85 patients aged 54.69 +/- 7.08 years were under dynamic observation. The patients had had diabetes and arterial hypertension (AH) for 5.99 +/- 4.37 and 8.65 +/- 5.52 years, respectively. The average HbAlc level was 7.91 +/- 1.73 mmol/ 1, total cholesterol level--6.35 +/- 1.81 mmol/l, body weight index--32.98 +/- 5.14 kg/m2. The average systolic and diastolic blood pressure levels were 162 +/- 7.6 and 97 +/- 3.4 mmHg, respectively. Carbohydrate and lipid exchange parameters, the extent of hyperinsulinemia and insulin resistance, and lipid peroxidation activity were evaluated. The functional condition of the endothelium was evaluated by D. Celermajer non-invasive measurement of flow-induced endothelium-dependent vasodilatation (EDVD) of the brachial artery (BA) using high-resolution ultrasound. 87% of the patients with type II diabetes and AH had endothelial dysfunction (ED), revealed by reactive hyperemia test; 30% of the patients had significant disorder of vasoreactivity (no BA artery diameter increase, but paradoxical vasoconstriction in response to reactive hyperemia). The presence and length of endothelial dysfunction (ED) in the patients with type II diabetes and AH depended on the length of diabetes, the length and extent of AH, and presence of long-term macro- and microvascular complications (coronary heart disease, diabetic retino- and nephropathy). The study did not found any dependence of the vasorelaxing endothelial function on glycosylated hemoglobin level, atherogenic blood lipid spectrum fractions, or lipid peroxidation activity. EDVD positively correlated with ApoA-1 protein level, reflecting the antiatherogenic potential of blood lipid spectrum.
该研究的目的是根据各种代谢因素评估II型糖尿病和动脉高血压患者内皮的功能状况。对85名年龄在54.69±7.08岁的患者进行了动态观察。这些患者患糖尿病和动脉高血压（AH）的时间分别为5.99±4.37年和8.65±5.52年。平均糖化血红蛋白水平为7.91±1.73 mmol/1，总胆固醇水平为6.35±1.81 mmol/l，体重指数为32.98±5.14 kg/m2。平均收缩压和舒张压水平分别为162±7.6和97±3.4 mmHg。评估了碳水化合物和脂质交换参数、高胰岛素血症和胰岛素抵抗程度以及脂质过氧化活性。通过使用高分辨率超声对肱动脉（BA）进行D. Celermajer无创测量血流诱导的内皮依赖性血管舒张（EDVD）来评估内皮的功能状况。通过反应性充血试验发现，87%的II型糖尿病和AH患者存在内皮功能障碍（ED）；30%的患者存在明显的血管反应性障碍（肱动脉直径无增加，但对反应性充血出现矛盾性血管收缩）。II型糖尿病和AH患者内皮功能障碍（ED）的存在和持续时间取决于糖尿病的病程、AH的病程和程度以及长期大血管和微血管并发症（冠心病、糖尿病视网膜病变和肾病）的存在。该研究未发现血管舒张内皮功能与糖化血红蛋白水平、致动脉粥样硬化血脂谱成分或脂质过氧化活性之间存在任何相关性。EDVD与反映血脂谱抗动脉粥样硬化潜力的载脂蛋白A-1蛋白水平呈正相关。
