Chan W B, Chan N N, Lai C W K, So W Y, Lo M K W, Lee K F, Chow C C, Metreweli C, Chan J C N
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong.
Kidney Int. 2006 Aug;70(4):711-6. doi: 10.1038/sj.ki.5001652.
There is a paucity of data on the effects of overt nephropathy and moderate renal impairment on endothelial function in diabetic patients. A total of 26 type II diabetic (DM) patients with nephropathy (DMN+) (mean +/- s.d. age: 63.7 +/- 6.3 years), 32 diabetic patients without nephropathy (DMN-) (59.4 +/- 10.1 years), and 52 non-diabetic subjects (54.9 +/- 8.2 years) were recruited. High-resolution ultrasound scan was used to measure carotid intima media thickness (IMT) and flow-mediated dilation (FMD) of the brachial artery. Endothelium-independent dilation was determined by maximal vascular dilation after sublingual nitroglycerine (glyceryl trinitrate (GTN)-induced dilation). The mean carotid IMT increased progressively from non-DM to DMN- to DMN+ groups (0.74 +/- 0.23 vs 0.80 +/- 0.25 vs 1.03 +/- 0.38 mm; P=0.001 for trend) whereas FMD- (4.3 +/- 2.5 vs 3.9 +/- 1.7 vs 1.9 +/- 2.0%, P<0.001 for trend) and GTN-induced dilation (14.7 +/- 4.0 vs 14.5 +/- 3.9 vs 10.3 +/- 3.2%; P<0.001 for trend) declined in an opposite manner. On multivariate analysis, age (beta=0.257, P=0.009), glomerular filtration rate (beta=-0.364, P<0.001), and smoking (beta=0.25, P=0.013) were independently associated with carotid IMT (F=15.76, R(2)=0.340, P<0.001). After adjustment for baseline brachial arterial diameter, history of smoking (beta=-0.039, P<0.001), fasting plasma glucose (beta=-0.033, P=0.002), and total cholesterol (beta=-0.023, P=0.024) were independently associated with vessel diameter after FMD (F=2446.5, R(2)=0.992, P<0.001); whereas age (beta=-0.069, P=0.001) and urinary albumin excretion (beta=-0.048, P=0.018) were independently associated with vessel diameter after GTN (F=851.6, R(2)=0.967, P<0.001). Type II diabetic patients with overt nephropathy and moderate renal impairment had both structural and functional vascular abnormalities beyond the endothelium.
关于显性肾病和中度肾功能损害对糖尿病患者内皮功能影响的数据较少。共招募了26例患有肾病的II型糖尿病(DM)患者(DMN+)(平均±标准差年龄:63.7±6.3岁)、32例无肾病的糖尿病患者(DMN-)(59.4±10.1岁)和52例非糖尿病受试者(54.9±8.2岁)。采用高分辨率超声扫描测量肱动脉的颈动脉内膜中层厚度(IMT)和血流介导的扩张(FMD)。通过舌下含服硝酸甘油(甘油三硝酸酯(GTN)诱导的扩张)后最大血管扩张来确定非内皮依赖性扩张。平均颈动脉IMT从非糖尿病组到DMN-组再到DMN+组逐渐增加(0.74±0.23 vs 0.80±0.25 vs 1.03±0.38 mm;趋势P=0.001),而FMD(4.3±2.5 vs 3.9±1.7 vs 1.9±2.0%,趋势P<0.001)和GTN诱导的扩张(14.7±4.0 vs 14.5±3.9 vs 10.3±3.2%;趋势P<0.001)则以相反的方式下降。多变量分析显示,年龄(β=0.257,P=0.009)、肾小球滤过率(β=-0.364,P<0.001)和吸烟(β=0.25,P=0.013)与颈动脉IMT独立相关(F=15.76,R(2)=0.340,P<0.001)。在调整基线肱动脉直径后,吸烟史(β=-0.039,P<0.001)、空腹血糖(β=-0.033,P=0.002)和总胆固醇(β=-0.023,P=0.024)与FMD后的血管直径独立相关(F=2446.5,R(2)=0.992,P<0.001);而年龄(β=-0.069,P=0.001)和尿白蛋白排泄(β=-0.048,P=0.018)与GTN后的血管直径独立相关(F=851.6,R(2)=0.967,P<0.001)。患有显性肾病和中度肾功能损害的II型糖尿病患者除内皮外还存在结构和功能上的血管异常。