Siró Péter, Molnár Csilla, Katona Eva, Antek Csaba, Kollár József, Settakis Georgios, Fülesdi Béla
Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Center, Debrecen, Hungary.
J Clin Ultrasound. 2009 Oct;37(8):451-6. doi: 10.1002/jcu.20617.
Diabetes mellitus (DM) is one of the leading risk factors for cerebrovascular diseases. Both macro- and microvascular damage may occur. The aim of the present work was to assess intima-media thickness as well as cerebral vasoreactivity in patients suffering from type 1 diabetes mellitus (IDDM).
Intima-media thickness and resting middle cerebral artery blood flow velocity was measured in 33 IDDM patients and 31 healthy controls. After baseline investigations, 30 seconds of breath holding (BH) and 60 seconds of voluntary hyperventilation (HV) were performed by the subjects. Transcranial Doppler measurements were performed in each case after vasodilatory (BH) and vasoconstrictor (HV) stimuli. Cerebrovascular reactivity was expressed as the percentage of change of the middle cerebral mean blood flow velocity after BH or HV.
IDDM patients showed a significantly larger intima-media thickness (0.1 +/- 0.02 mm) than healthy controls (0.06 +/- 0.006 mm, p < 0.001). Cerebrovascular reactivity after BH was less intensive in diabetic patients (19.3 +/- 16.1%) than that of the control subjects (38.7 +/- 22.8%, p < 0.01). Similarly, HV induced a less-pronounced decrease of cerebral blood flow velocity in diabetic subjects (-30.1 +/- 13.2%) than in nondiabetics (-37.6 +/- 17.0%, p < 0.05).
Our results refer to early macro- and microangiopathic involvement of the cerebral vessels, which develop in parallel with angiopathies of the other organs, such as nephropathy and retinopathy. Further prospective studies are needed to clarify the role of these macro- and microangiopathic changes in the development of cerebrovascular complications in patients suffering from DM.
糖尿病（DM）是脑血管疾病的主要危险因素之一。可能会发生大血管和微血管损伤。本研究的目的是评估1型糖尿病（IDDM）患者的内膜中层厚度以及脑血管反应性。
对33例IDDM患者和31例健康对照者测量内膜中层厚度和静息状态下大脑中动脉血流速度。在进行基线检查后，受试者进行30秒屏气（BH）和60秒自主过度通气（HV）。在血管舒张（BH）和血管收缩（HV）刺激后，对每种情况进行经颅多普勒测量。脑血管反应性以BH或HV后大脑中平均血流速度的变化百分比表示。
IDDM患者的内膜中层厚度（0.1±0.02mm）明显大于健康对照者（0.06±0.006mm，p<0.001）。糖尿病患者BH后的脑血管反应性（19.3±16.1%）比对照组受试者（38.7±22.8%，p<0.01）弱。同样，HV引起糖尿病受试者大脑血流速度的下降（-30.1±13.2%）比非糖尿病患者（-37.6±17.0%，p<0.05）不明显。
我们的结果表明，脑血管早期存在大血管和微血管病变，这些病变与其他器官（如肾病和视网膜病变）的血管病变同时发生。需要进一步的前瞻性研究来阐明这些大血管和微血管病变在DM患者脑血管并发症发生发展中的作用。
