Ishiyama Masami, Suzuki Eiji, Katsuda Jun, Murase Hiroshi, Tajima Yoshitaka, Horikawa Yukio, Goto Shinobu, Fujita Tamio, Takeda Jun
Department of Diabetes and Endocrinology, Gifu University School of Medicine, Gifu, Japan.
Diabetes Res Clin Pract. 2009 Aug;85(2):189-96. doi: 10.1016/j.diabres.2009.04.023. Epub 2009 Jun 3.
Vascular calcification is frequently accompanied by intima-media thickening, but the associations among these atherosclerotic features and bone-related peptides in diabetic patients are unclear. We enrolled 168 type 2 diabetic patients and 40 non-diabetic subjects consecutively admitted to our hospital. Mean intima-media thickness (mean-IMT) in common carotid arteries was measured by B-mode ultrasonography. Agatston coronary artery calcium score (CACS) was obtained using multidetector-row computed tomography (MDCT). Plasma bone-related peptides osteopontin and osteoprotegerin levels were measured. Diabetic patients had higher mean-IMT (p=0.0002) and log(CACS+1) (p<0.0001) and similar bone-related peptides compared to non-diabetic subjects. In diabetic patients classified into tertiles according to their CACS levels, those with the highest scores showed the highest mean-IMT (p=0.0004) and bone-related peptides (p<0.05) among the groups. log(CACS+1) and mean-IMT were associated (p<0.0001) and were positively correlated with osteopontin (p<0.01) and osteoprotegerin (p<0.01) in diabetic patients. Multivariate analyses revealed that the significant independent determinants of log(CACS+1) were age, duration of diabetes and osteopontin (p<0.0001) and those of mean-IMT were age, hypertension, osteopontin and osteoprotegerin (p<0.0001), respectively. We have demonstrated that vascular calcification in type 2 diabetic patients is frequently accompanied by intima-media thickening, and osteopontin may act as a vascular calcification inhibitor by increasing intima-media thickness.
血管钙化常伴有内膜中层增厚，但在糖尿病患者中，这些动脉粥样硬化特征与骨相关肽之间的关联尚不清楚。我们连续纳入了168例2型糖尿病患者和40例非糖尿病受试者，这些患者均为我院收治。采用B型超声测量颈总动脉的平均内膜中层厚度（mean-IMT）。使用多排螺旋计算机断层扫描（MDCT）获得阿加斯顿冠状动脉钙化评分（CACS）。检测血浆骨相关肽骨桥蛋白和骨保护素水平。与非糖尿病受试者相比，糖尿病患者的mean-IMT更高（p=0.0002），log（CACS+1）更高（p<0.0001），而骨相关肽水平相似。在根据CACS水平分为三分位数的糖尿病患者中，得分最高的组的mean-IMT最高（p=0.0004），骨相关肽水平也最高（p<0.05）。在糖尿病患者中，log（CACS+1）与mean-IMT相关（p<0.0001），且与骨桥蛋白（p<0.01）和骨保护素（p<0.01）呈正相关。多变量分析显示，log（CACS+1）的显著独立决定因素是年龄、糖尿病病程和骨桥蛋白（p<0.0001），而mean-IMT的显著独立决定因素分别是年龄、高血压、骨桥蛋白和骨保护素（p<0.0001）。我们已经证明，2型糖尿病患者的血管钙化常伴有内膜中层增厚，骨桥蛋白可能通过增加内膜中层厚度而作为血管钙化抑制剂发挥作用。
