Choudhary Bikram P, Antoniades Charalambos, Brading Alison F, Galione Antony, Channon Keith, Taggart David P
Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
J Am Coll Cardiol. 2007 Sep 11;50(11):1047-53. doi: 10.1016/j.jacc.2007.06.008. Epub 2007 Aug 24.
Our purpose was to examine the impact of diabetes mellitus (DM) on vasoreactivity and endothelial function of radial artery (RA) grafts ex vivo.
The arteriopathy associated with DM may influence the surgeon's choice of conduits for revascularization. Arterial conduits and especially the RA are prone to vasospasm in the perioperative period.
The study population consisted of 98 patients with coronary artery disease undergoing coronary artery bypass grafting by using RA grafts. The maximum contractions of RA segments induced by K+ (66 mmol/l) and clinically important vasoconstrictors such as adrenaline (5 x 10(-5) mol/l), angiotensin II (10(-6) mol/l), and prostaglandin F2alpha (PGF2alpha) (10(-6) mol/l) were recorded. Relaxation of RA rings to carbachol (10(-4) mol/l) was used as a measure of endothelial function. Multivariate analysis was then applied to determine the role of clinical characteristics on the vasomotor responses to these agents.
Vessels from patients with DM had greater contractions in response to adrenaline (p < 0.05), angiotensin (p < 0.05), and PGF2alpha (p < 0.01) compared with non-DM vessels, despite the similar vasoconstrictions induced by high K+ (p = NS). Diabetes mellitus was also associated with smaller vasorelaxations in response to carbachol (p < 0.001). In multivariate analysis, DM was an independent predictor of RA contractions in response to adrenaline (beta [SE] 3.085 [1.410], p = 0.031), angiotensin II (beta [SE] 3.838 [1.552], p = 0.015), and PGF2alpha (beta [SE] 4.609 [1.908], p = 0.018) but not K+ (p = NS). Diabetes mellitus was also independently associated with the vasorelaxations in response to carbachol (beta [SE] -15.645 [2.622], p = 0.0001).
Diabetes mellitus is associated with impaired endothelial function and greater contractions of RA grafts in response to all of the clinically relevant vasoconstrictors. These findings suggest that the RA of diabetic patients may be more prone to spasm in response to endogenous vasoconstrictors, an observation with important implications for surgeons' choice of conduits in this cohort of patients.
我们的目的是在体外研究糖尿病（DM）对桡动脉（RA）移植物血管反应性和内皮功能的影响。
与DM相关的动脉病变可能会影响外科医生选择用于血管重建的血管。动脉血管尤其是RA在围手术期容易发生血管痉挛。
研究人群包括98例接受冠状动脉搭桥术并使用RA移植物的冠心病患者。记录由K +（66 mmol / l）以及临床上重要的血管收缩剂如肾上腺素（5×10（-5）mol / l）、血管紧张素II（10（-6）mol / l）和前列腺素F2α（PGF2α）（10（-6）mol / l）诱导的RA节段的最大收缩。将RA环对卡巴胆碱（10（-4）mol / l）的舒张用作内皮功能的指标。然后应用多变量分析来确定临床特征对这些药物血管运动反应的作用。
与非DM血管相比，DM患者的血管对肾上腺素（p <0.05）、血管紧张素（p <0.05）和PGF2α（p <0.01）的收缩反应更大，尽管高K +诱导的血管收缩相似（p =无显著性差异）。DM也与对卡巴胆碱的血管舒张较小有关（p <0.001）。在多变量分析中，DM是RA对肾上腺素（β[标准误] 3.085 [1.410]，p = 0.031）、血管紧张素II（β[标准误] 3.838 [1.552]，p = 0.015）和PGF2α（β[标准误] 4.609 [1.908]，p = 0.018）收缩反应的独立预测因子，但不是对K +（p =无显著性差异）。DM也与对卡巴胆碱的血管舒张独立相关（β[标准误] -15.645 [2.622]，p = 0.0001）。
DM与内皮功能受损以及RA移植物对所有临床相关血管收缩剂的收缩反应增强有关。这些发现表明糖尿病患者的RA对内源性血管收缩剂的反应可能更容易发生痉挛，这一观察结果对该组患者外科医生选择血管具有重要意义。
