Futrakul Narisa, Butthep Punnee, Vongthavarawat Varaphon, Futrakul Prasit, Sirisalipoch Sasitorn, Chaivatanarat Tawatchai, Suwanwalaikorn Sompongse
Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Clin Hemorheol Microcirc. 2006;34(3):373-81.
This paper was aimed to investigate (1) the early marker of endothelial injury in type 2 diabetes, (2) the intrarenal hemodynamics and renal function, and (3) the therapeutic strategy aiming to restore renal function. Fifty patients (35 normoalbuminuric and 15 albuminuric type 2 diabetes) were examined. Blood was collected for determination of circulating vascular endothelial cells (CEC) and the serum was prepared for determination of transforming growth factor beta (TGFbeta), ratio of CEC/TGFbeta, and soluble vascular cell adhesion molecule. Intrarenal hemodynamics and renal function were also assessed. The results showed that increased number of circulating EC, elevated TGFbeta and depleted ratio of CEC/TGFbeta were significantly observed. Intrarenal hemodynamic study revealed a hemodynamic maladjustment characterized by preferential constriction of the efferent arteriole, intraglomerular hypertension and reduction in peritubular capillary flow. It was concluded that early marker of endothelial injury is reflected by increasing number of CEC. Such markers correlate with the glomerular endothelial dysfunction associated with hemodynamic maladjustment. Early detection of endothelial injury and appropriate correction of hemodynamic maladjustment by multidrug vasodilators can effectively restore renal function in type 2 diabetic nephropathy.
（1）2型糖尿病患者内皮损伤的早期标志物；（2）肾内血流动力学和肾功能；（3）旨在恢复肾功能的治疗策略。对50例患者（35例正常白蛋白尿和15例白蛋白尿2型糖尿病患者）进行了检查。采集血液以测定循环血管内皮细胞（CEC），制备血清以测定转化生长因子β（TGFβ）、CEC/TGFβ比值和可溶性血管细胞黏附分子。同时评估肾内血流动力学和肾功能。结果显示，循环内皮细胞数量增加、TGFβ升高以及CEC/TGFβ比值降低均有显著表现。肾内血流动力学研究显示存在血流动力学失调，其特征为出球小动脉优先收缩、肾小球内高压以及肾小管周围毛细血管血流减少。研究得出结论，内皮损伤的早期标志物表现为CEC数量增加。这些标志物与血流动力学失调相关的肾小球内皮功能障碍有关。早期检测内皮损伤并通过多种血管扩张剂适当纠正血流动力学失调，可有效恢复2型糖尿病肾病患者的肾功能。
