Meyer M F, Lieps D, Schatz H, Klein H H, Pfohl M
Department of Internal Medicine, University Clinic Bergmannsheil, Ruhr-University Bochum, Germany.
Exp Clin Endocrinol Diabetes. 2008 May;116(5):298-304. doi: 10.1055/s-2008-1042404. Epub 2008 Feb 14.
The increased incidence of atherosclerotic macrovascular disease in type 2 diabetic patients is associated both with diabetes specific factors and coexisting classic cardiovascular risk factors as components of the metabolic syndrome. The aim of this study was to investigate the association between the duration of diabetes and early functional and morphological markers of atherosclerosis compared to the impact of coexisting cardiovascular risk factors such as hypertension, dyslipoproteinemia and cigarette smoking.
63 type 2 diabetic patients and 25 non-diabetic control subjects were investigated. Lumen diameter of the brachial artery was measured by high-resolution ultrasound at rest and after 5-min suprasystolic arterial compression. Endothelium-independent dilatation of the brachial artery was measured 4 min after sublingual administration of 400 mug of glycerol trinitrate (GTN). Percentage change of arterial lumen diameter during reactive hyperemia (FMD%) and after GTN administration (GTN%) relative to the baseline measurements were calculated. The intima-media thickness (IMT) of the common carotid artery was measured bilaterally and averages were calculated.
FMD% (3.8+/-0.8% vs. 6.9+/-0.9%; p<0.01) and GTN% (5.6+/-0.7% vs. 14.9+/-1.7%; p<0.01) were reduced in the diabetic patients compared to their control subjects. IMT was increased in diabetic patients compared to their controls (0.82+/-0.02 mm vs. 0.62+/-0.02 mm; p<0.01). The age-adjusted diabetes duration was inversely related to FMD% (r=-0.27; p=0.016). On multiple regression analysis including packyears, hypertension, hypercholesterolemia, and hypertriglyceridemia, only diabetes duration remained a significant independent determinant of FMD. GTN% and IMT were not associated with diabetes duration, packyears, hypertension, hypercholesterolemia, and hypertriglyceridemia when all variables were taken into account.
The present data lend support to the suggestion that diabetic specific factors compared to coexisting cardiovascular risk factors such as hypertension, hyperlipoproteinemia, and smoking are of major importance for the pathogenesis of endothelial dysfunction in type 2 diabetes, because only the diabetes duration was shown to be related to endothelium-dependent vasodilation when all variables were taken into account.
2型糖尿病患者动脉粥样硬化性大血管疾病发病率的增加与糖尿病特异性因素以及作为代谢综合征组成部分的并存经典心血管危险因素有关。本研究的目的是调查糖尿病病程与动脉粥样硬化早期功能和形态学标志物之间的关联，并与并存的心血管危险因素如高血压、血脂异常和吸烟的影响进行比较。
对63例2型糖尿病患者和25例非糖尿病对照者进行了研究。通过高分辨率超声在静息状态下和5分钟的收缩期以上动脉压迫后测量肱动脉的管腔直径。在舌下含服400μg硝酸甘油（GTN）4分钟后测量肱动脉的内皮非依赖性扩张。计算反应性充血期间（FMD%）和给予GTN后（GTN%）动脉管腔直径相对于基线测量值的百分比变化。双侧测量颈总动脉的内膜中层厚度（IMT）并计算平均值。
与对照者相比，糖尿病患者的FMD%（3.8±0.8%对6.9±0.9%；p<0.01）和GTN%（5.6±0.7%对14.9±1.7%；p<0.01）降低。与对照者相比，糖尿病患者的IMT增加（0.82±0.02mm对0.62±0.02mm；p<0.01）。年龄校正后的糖尿病病程与FMD%呈负相关（r=-0.27；p=0.016）。在包括吸烟包年数、高血压、高胆固醇血症和高甘油三酯血症的多元回归分析中，只有糖尿病病程仍然是FMD的一个显著独立决定因素。当考虑所有变量时，GTN%和IMT与糖尿病病程、吸烟包年数、高血压、高胆固醇血症和高甘油三酯血症无关。
目前的数据支持以下观点，即与并存的心血管危险因素如高血压、高脂蛋白血症和吸烟相比，糖尿病特异性因素对2型糖尿病内皮功能障碍的发病机制更为重要，因为当考虑所有变量时，只有糖尿病病程与内皮依赖性血管舒张有关。
