冠状动脉壁的结构改变与2型糖尿病患者的心肌血流异质性有关。
Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus.
作者信息
Schindler Thomas H, Facta Alvaro D, Prior John O, Cadenas Jerson, Zhang Xiao-Li, Li Yanjie, Sayre James, Goldin Jonathan, Schelbert Heinrich R
机构信息
Department of Molecular and Medical Pharmacology, Radiological Science, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 23-120 CHS, P.O. Box 173517, Los Angeles, CA 90095-1735, USA.
出版信息
Eur J Nucl Med Mol Imaging. 2009 Feb;36(2):219-29. doi: 10.1007/s00259-008-0885-z. Epub 2008 Aug 15.
PURPOSE
To determine the relationship between carotid intima-media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM).
METHODS
In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with (13)N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation.
RESULTS
There was neither a relationship between carotid IMT and CAC (r = 0.10, p = 0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r = -0.18, p = 0.25 and r = 0.10, p = 0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44 +/- 18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69 +/- 0.24 vs. 0.74 +/- 0.23 and 1.82 +/- 0.50 vs. 1.95 +/- 0.51 ml/g/min; p < or = 0.05, respectively) and also during CPT in DM but less pronounced (0.81 +/- 0.24 vs. 0.83 +/- 0.23 ml/g/min; p = ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r = -0.36, p < or = 0.014; r = -0.46, p < or = 0.007; and r = -0.33, p < or = 0.041, respectively).
CONCLUSIONS
The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall.
目的
确定2型糖尿病（DM）患者静息及血管舒缩应激状态下颈动脉内膜中层厚度（IMT）、冠状动脉钙化（CAC）和心肌血流量（MBF）之间的关系。
方法
对68例个体，使用高分辨率血管超声测量颈动脉IMT，同时用电子束断层扫描（EBT）确定CAC的存在情况。静息状态、冷加压试验（CPT）期间及腺苷（ADO）刺激期间，用（13）N-氨和正电子发射断层扫描（PET）以每分钟每克毫升数测定整体和局部MBF。
结果
颈动脉IMT与CAC之间无相关性（r = 0.10，p = 0.32），在CPT期间及ADO刺激时，颈动脉IMT与冠状动脉循环功能之间也无相关性（分别为r = -0.18，p = 0.25和r = 0.10，p = 0.54）。在33例个体中，EBT检测到CAC，平均阿加斯顿衍生钙评分为44±18。静息状态及ADO刺激充血期间，有CAC和无CAC区域的局部MBF存在显著差异（分别为0.69±0.24 vs. 0.74±0.23以及1.82±0.50 vs. 1.95±0.51 ml/g/min；p≤0.05），在DM患者的CPT期间差异较小（0.81±0.24 vs. 0.83±0.23 ml/g/min；p = 无显著性差异）。CAC增加的同时，静息以及CPT和ADO相关的MBF局部逐渐减少（分别为r = -0.36，p≤0.014；r = -0.46，p≤0.007；r = -0.33，p≤0.041）。
结论
2型DM患者颈动脉IMT与冠状动脉循环功能之间无任何相关性，提示外周和冠状动脉循环中早期动脉粥样硬化具有不同特征和阶段。PET测量的静息及血管舒缩应激状态下的MBF异质性可能反映了与冠状动脉疾病（CAD）相关的动脉壁早期结构改变的下游流体动力学效应。
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