在踝臂指数正常的2型糖尿病患者中，较高的动脉僵硬度、较大的外周血管阻力以及小腿动脉较低的血流量与长期高血糖有关。

Higher arterial stiffness, greater peripheral vascular resistance and lower blood flow in lower-leg arteries are associated with long-term hyperglycaemia in type 2 diabetic patients with normal ankle-brachial index.

作者信息

Suzuki Eiji, Yoshimura Toru, Omura Yasushi, Sakaguchi Masayoshi, Nishio Yoshihiko, Maegawa Hiroshi, Hisatomi Akitaka, Fujimoto Kazuma, Takeda Jun, Kashiwagi Atsunori

机构信息

Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan.

出版信息

Diabetes Metab Res Rev. 2009 May;25(4):363-9. doi: 10.1002/dmrr.955.

DOI:10.1002/dmrr.955

PMID:19334018

Abstract

BACKGROUND

Higher arterial stiffness and greater peripheral vascular resistance reduce blood flow in lower-leg arteries and contribute to the development of ischaemic limb in diabetic patients even without peripheral artery occlusive disease. The aim of this study was to clarify whether these vascular parameters are associated with long-term hyperglycaemia in diabetic patients.

METHODS

We examined 45 type 2 diabetic patients and 38 age-matched nondiabetic subjects without peripheral artery occlusive disease assessed by ankle-brachial index consecutively admitted to our hospital, and followed them over a 3-year period (3.7 +/- 0.7 years) with no vasodilative medication. Blood flow and resistive index, a measure of peripheral vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial-ankle pulse wave velocity was measured to assess arterial stiffness.

RESULTS

At baseline, consistent with our previous report, diabetic patients showed higher brachial-ankle pulse wave velocity (p < 0.0001) and resistive index (p < 0.0001) and lower flow volume (p = 0.0044) than those of nondiabetic subjects. Stepwise multiple regression analysis revealed that duration of diabetes, mean HbA(1c) during the study, use of renin-angiotensin system inhibitors and change per year in resistive index were identified as significant independent variables predicting change per year in blood flow (r(2) = 0.733, p < 0.0001) in diabetic patients. Mean HbA(1c) during the study was positively correlated with changes per year in brachial-ankle pulse wave velocity (p = 0.00007) and resistive index (p = 0.0014) and was negatively correlated with that in blood flow (p < 0.0001) in diabetic patients.

CONCLUSIONS

Long-term hyperglycaemia is a major cause of impaired peripheral circulation in lower-leg arteries in diabetic patients without peripheral artery occlusive disease.

摘要

背景

较高的动脉僵硬度和较大的外周血管阻力会减少小腿动脉的血流，即使在没有外周动脉闭塞性疾病的情况下，也会促使糖尿病患者发生缺血性肢体病变。本研究的目的是阐明这些血管参数是否与糖尿病患者的长期高血糖有关。

方法

我们连续纳入了我院收治的45例2型糖尿病患者和38例年龄匹配、无外周动脉闭塞性疾病的非糖尿病受试者，通过踝臂指数进行评估，并在3年期间（3.7±0.7年）未使用血管扩张药物对他们进行随访。使用门控二维电影模式相位对比磁共振成像评估腘动脉的血流和阻力指数（一种外周血管阻力的测量指标）。测量肱踝脉搏波速度以评估动脉僵硬度。

结果

在基线时，与我们之前的报告一致，糖尿病患者的肱踝脉搏波速度（p<0.0001）、阻力指数（p<0.0001）较高，而血流量较低（p=0.0044）。逐步多元回归分析显示，糖尿病病程、研究期间的平均糖化血红蛋白（HbA1c）、肾素-血管紧张素系统抑制剂的使用以及阻力指数每年的变化被确定为预测糖尿病患者血流量每年变化的显著独立变量（r2=0.733，p<0.0001）。研究期间的平均HbA1c与糖尿病患者肱踝脉搏波速度每年的变化（p=0.00007）和阻力指数每年的变化（p=0.0014）呈正相关，与血流量每年的变化呈负相关（p<0.0001）。