Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan. hiroki@m2,octv.ne.jp
J Atheroscler Thromb. 2011;18(9):744-52. doi: 10.5551/jat.7526. Epub 2011 May 20.
To investigate whether endothelial dysfunction assessed by brachial artery flow-mediated dilation (FMD) is associated with urinary albumin excretion (UAE) and is interrelated with carotid intima-media thickness (IMT) and pulse-wave velocity (PWV) in type 2 diabetes.
We measured FMD, IMT and PWV in 158 subjects with type 2 diabetes (normo- 49, micro- 64, macroalbuminuria 45), explored the determinants of FMD, and analyzed the relationship of FMD with traditional cardiovascular risk factors according to IMT and PWV levels.
Microalbuminuria was significantly associated with lower FMD, higher IMT and higher PWV compared to normoalbuminuria (p < 0.001 for all). FMD was significantly correlated with IMT and PWV, and also with traditional risk factors, UAE, glomerular filtration rate, diabetic retinopathy, and neuropathy. Multivariate regression analysis revealed that UAE remained a significant determinant of FMD independent of traditional risk factors, metabolic control, and renal function. The relationship of FMD with IMT and PWV was less pronounced in subjects with increased IMT and PWV.
In individuals with type 2 diabetes, FMD is impaired in subjects with microalbuminuria and is associated with IMT and PWV only when these values are not increased, i.e., at an early stage of atherosclerosis.
研究 2 型糖尿病患者肱动脉血流介导的舒张功能（FMD）是否与尿白蛋白排泄（UAE）相关，以及与颈动脉内膜中层厚度（IMT）和脉搏波速度（PWV）是否相互关联。
我们测量了 158 例 2 型糖尿病患者（正常白蛋白尿 49 例、微量白蛋白尿 64 例、大量白蛋白尿 45 例）的 FMD、IMT 和 PWV，探讨了 FMD 的决定因素，并根据 IMT 和 PWV 水平分析了 FMD 与传统心血管危险因素的关系。
与正常白蛋白尿相比，微量白蛋白尿患者的 FMD 明显降低，IMT 和 PWV 明显升高（p < 0.001）。FMD 与 IMT 和 PWV 显著相关，与传统危险因素、UAE、肾小球滤过率、糖尿病视网膜病变和神经病变也显著相关。多元回归分析显示，UAE 是 FMD 的独立决定因素，独立于传统危险因素、代谢控制和肾功能。在 IMT 和 PWV 增加的患者中，FMD 与 IMT 和 PWV 的关系不那么明显。
在 2 型糖尿病患者中，FMD 在微量白蛋白尿患者中受损，并且仅在这些值没有增加（即动脉粥样硬化的早期阶段）时与 IMT 和 PWV 相关。
