Poredos P, Kek Ljubec A, Poredos P, Visnovic Poredos A
Department for Vascular Diseases, University Clinical Center, Ljubljana, Slovenia.
Int Angiol. 2006 Sep;25(3):280-6.
We examined whether alteration in vascular endothelial function exists in non-insulin dependent diabetes mellitus (NIDDM) and whether impaired endothelium-dependent responses in those patients are associated with increased intima-media thickness (IMT), the time sequence of their appearance and the role of individual risk factors in development of structural deterioration of arterial wall.
Ultrasound technique was used to measure brachial artery flow mediated dilation (FMD) response and carotid IMT in 38 young adults with type I diabetes aged 22-34 years and 35 healthy controls aged 22-36 years.
Patients had significantly lower FMD than controls (4.15/2.8/ vs 11.3/3.6/, P<0.0001) and was in all diabetic patients below the mean value of controls. Further, carotid intima-media was in insulin dependent diabetes mellitus (IDDM) patients significantly thicker than in healthy subjects (0.65/0.04 vs 0.56/0.04, P=0.0001) and was related to body mass and body mass index, to the age of patients, the duration of diabetes and several risk variables. In a multivariate model FMD was most significantly and independently associated to IMT. However, significant thickening of intima-media was observed only in patients with progressed deterioration of FMD and it appeared in those subjects with long-lasting disease. IMT was also influenced by urinary albumin excretion and low-density lipoprotein (LDL) cholesterol concentration.
Endothelium dependent FMD response is impaired in IDDM and is associated with increased carotid artery IMT. Significant thickening of intima-media appears in patients with advanced deterioration of FMD that is related to the duration of the disease. These data suggest that advanced endothelial dysfunction in IDDM may predispose to development of morphologic atherosclerotic lesions of arterial wall.
我们研究了非胰岛素依赖型糖尿病（NIDDM）患者是否存在血管内皮功能改变，以及这些患者内皮依赖性反应受损是否与内膜中层厚度（IMT）增加、其出现的时间顺序以及个体危险因素在动脉壁结构恶化发展中的作用有关。
采用超声技术测量38名年龄在22 - 34岁的I型糖尿病年轻成年人及35名年龄在22 - 36岁的健康对照者的肱动脉血流介导的扩张（FMD）反应和颈动脉IMT。
患者的FMD显著低于对照组（4.15/2.8/对11.3/3.6/，P<0.0001），且所有糖尿病患者的FMD均低于对照组平均值。此外，胰岛素依赖型糖尿病（IDDM）患者的颈动脉内膜中层明显比健康受试者厚（0.65/0.04对0.56/0.04，P = 0.0001），且与体重、体重指数、患者年龄、糖尿病病程及多个风险变量相关。在多变量模型中，FMD与IMT最显著且独立相关。然而，仅在FMD进展恶化的患者中观察到内膜中层显著增厚，且出现在病程较长的患者中。IMT还受尿白蛋白排泄和低密度脂蛋白（LDL）胆固醇浓度影响。
IDDM患者的内皮依赖性FMD反应受损，且与颈动脉IMT增加有关。FMD严重恶化的患者出现内膜中层显著增厚，这与疾病病程有关。这些数据表明，IDDM患者晚期内皮功能障碍可能易导致动脉壁形态学动脉粥样硬化病变的发展。
