Petrica Ligia, Petrica Maxim, Vlad Adrian, Bob Flaviu, Gluhovschi Cristina, Gluhovschi Gheorghe, Jianu Catalin D, Ursoniu Sorin, Schiller Adalbert, Velciov Silvia, Trandafirescu Virginia, Bozdog Gheorghe
Department of Nephrology, University of Medicine and Pharmacy, Timisoara, Romania.
Wien Klin Wochenschr. 2007;119(11-12):365-71. doi: 10.1007/s00508-007-0809-0.
Cerebrovascular reactivity (CVR) is a hemodynamic parameter representing the increase in normal cerebral artery blood flow in response to a vasodilatory stimulus such as hypercapnia.
The aim of the study was to assess CVR using transcranial Doppler ultrasound and the breath-holding test (BHT) in normotensive patients with non-insulin-dependent diabetes mellitus (NIDDM). The cerebrovascular response to hypercapnia was evaluated in relation to risk factors for cerebral microangiopathy.
The study was carried out in a group of 34 normotensive NIDDM patients and a group of 31 sex- and age-matched normal controls. The NIDDM group was subdivided into 21 patients with microangiopathic complications (Group A, 12 men, 9 women; mean age 58.77 +/- 8.91 years) and 13 patients with no such complications (Group B, 8 men, 5 women; mean age 56.34 +/- 9.83 years). The control group comprised 17 men and 14 women (Group C, mean age 58.43 +/- 6.31 years). Exclusion criteria were hypertension and past or present symptomatic cerebrovascular disease. The BHT consisted of spontaneous hypercapnia induced by holding the breath for 20 seconds. CVR was estimated in relation to the increase in the mean flow velocity (MFV) compared with the basal velocity in both middle cerebral arteries during hypercapnia.
In Group A, the CVR was significantly decreased in 71.42% of patients, whereas in Group B only 30.76% of patients presented with mildly to moderately impaired CVR. Predictors for impaired % increase in the MFV during the BHT demonstrated by univariate regression analysis were: duration of diabetes (r = 0.802; P < 0.0001), fibrinogen (r = 0.574; P < 0.0001), C-reactive protein (r = 0.525; P < 0.001), proteinuria (r = 0.924; P < 0.0001) and serum creatinine (r = 0.969; P < 0.0001). Multivariate regression analysis showed as predictors: duration of diabetes (P < 0.0001), proteinuria (P < 0.0001) and serum creatinine (P < 0.0001).
CVR is impaired in normotensive NIDDM patients. These cerebral hemodynamic changes correlate significantly with the duration of DM, parameters of inflammation, proteinuria and serum creatinine.
脑血管反应性（CVR）是一种血流动力学参数，代表正常脑动脉血流在诸如高碳酸血症等血管舒张刺激下的增加。
本研究旨在使用经颅多普勒超声和屏气试验（BHT）评估非胰岛素依赖型糖尿病（NIDDM）正常血压患者的CVR。评估了脑血管对高碳酸血症的反应与脑微血管病危险因素的关系。
研究对象为34例正常血压的NIDDM患者和31例性别及年龄匹配的正常对照者。NIDDM组又分为21例有微血管并发症的患者（A组，男12例，女9例；平均年龄58.77±8.91岁）和13例无此类并发症的患者（B组，男8例，女5例；平均年龄56.34±9.83岁）。对照组包括17例男性和14例女性（C组，平均年龄58.43±6.31岁）。排除标准为高血压以及既往或目前有症状性脑血管疾病。BHT包括屏气20秒诱发的自发性高碳酸血症。根据高碳酸血症期间双侧大脑中动脉平均流速（MFV）相对于基础流速的增加来估计CVR。
在A组中，71.42%的患者CVR显著降低，而在B组中只有30.76%的患者表现为轻度至中度CVR受损。单因素回归分析显示，BHT期间MFV增加百分比受损的预测因素为：糖尿病病程（r = 0.802；P < 0.0001）、纤维蛋白原（r = 0.574；P < 0.0001）、C反应蛋白（r = 0.525；P < 0.001）、蛋白尿（r = 0.924；P < 0.0001）和血清肌酐（r = 0.969；P < 0.0001）。多因素回归分析显示预测因素为：糖尿病病程（P < 0.0001）、蛋白尿（P < 0.0001）和血清肌酐（P < 0.0001）。
正常血压的NIDDM患者CVR受损。这些脑血流动力学变化与糖尿病病程、炎症参数、蛋白尿和血清肌酐显著相关。
