Steno Diabetes Center, Gentofte, Denmark.
Cardiovasc Diabetol. 2011 Aug 3;10:71. doi: 10.1186/1475-2840-10-71.
Intensive multifactorial treatment aimed at cardiovascular (CV) risk factor reduction in type 2 diabetic patients with microalbuminuria can diminish fatal and non-fatal CV. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the utility of P-NT-proBNP in screening for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment.
P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score≥400, carotid intima-media thickness (CIMT)>0.90 mm, ankle-brachial index<0.90, and/or toe-brachial index<0.64, respectively. Carotid artery compliance was also determined and the reactive hyperaemia index (RHI) measured by peripheral artery tonometry was used as a surrogate for endothelial function.P-NT-proBNP was associated with atherosclerosis in the unadjusted analysis, but not after adjustment for conventional risk factors. P-NT-proBNP was not associated with vascular dysfunction. The prevalence of atherosclerosis in the coronary, carotid and peripheral arteries was 35%, 10% and 21% of all patients, respectively. In total 49% had atherosclerosis in one territory and 15.6% and 1.0% in two and three territories. Low RHI was an independent predictor of coronary atherosclerosis (odds ratio [CI], 2.60 [1.15-5.88] and systolic blood pressure was the only independent determinant of CIMT (0.02 mm increase in CIMT per 10 mmHg increase in systolic blood pressure [p=0.003]).
Half of asymptomatic patients with type 2 diabetes mellitus and microalbuminuria had significant atherosclerosis in at least one vascular territory despite receiving intensive multifactorial treatment for CV risk reduction. Coronary atherosclerosis was most prevalent, whereas carotid disease was more rarely observed. RHI but not plasma NT-proBNP was predictive of coronary atherosclerosis.
研究接受强化多因素治疗的 2 型糖尿病伴微量白蛋白尿患者的血浆氨基末端脑钠肽前体（P-NT-proBNP）与动脉粥样硬化及血管功能障碍之间的关系。
入选 200 例接受强化多因素治疗以降低心血管风险的、无症状的 2 型糖尿病伴微量白蛋白尿患者，测量其 P-NT-proBNP。根据冠状动脉钙评分≥400、颈动脉内膜中层厚度（CIMT）>0.90mm、踝肱指数<0.90 及/或趾肱指数<0.64 ，分别定义为冠状动脉、颈动脉和外周动脉粥样硬化，评估患者的冠状动脉、颈动脉和外周动脉粥样硬化情况。还测定了颈动脉顺应性，并通过外周动脉张力测定来测量反应性充血指数（RHI），作为内皮功能的替代指标。在未校正分析中，P-NT-proBNP 与动脉粥样硬化相关，但在调整了传统危险因素后，两者不再相关。P-NT-proBNP 与血管功能障碍无关。在所有患者中，冠状动脉、颈动脉和外周动脉粥样硬化的患病率分别为 35%、10%和 21%。总的来说，有 49%的患者在一个部位有动脉粥样硬化，15.6%和 1.0%的患者在两个和三个部位有动脉粥样硬化。低 RHI 是冠状动脉粥样硬化的独立预测因子（比值比[CI]，2.60[1.15-5.88]），收缩压是 CIMT 的唯一独立决定因素（收缩压每增加 10mmHg，CIMT 增加 0.02mm[p=0.003]）。
尽管接受强化多因素治疗以降低心血管风险，但仍有一半的无症状 2 型糖尿病伴微量白蛋白尿患者在至少一个血管部位存在明显的动脉粥样硬化。冠状动脉粥样硬化最常见，而颈动脉疾病则较少见。RHI 而非 P-NT-proBNP 可预测冠状动脉粥样硬化。
