Department of Surgery, University of Pisa, via Paradisa 2, Pisa, 56 124, Italy.
Cardiovasc Diabetol. 2011 Oct 8;10:88. doi: 10.1186/1475-2840-10-88.
Carotid intima-media thickness (IMT), indices of large artery stiffness and measures of endothelium function may be used as markers of early atherosclerosis in type 1 diabetes mellitus (T1DM). The aim of the present study was to compare the indices of large artery structure and function as well as endothelial function and regenerating capacity between adolescents with T1DM and healthy control of similar age. In addition, the associations of different vascular measures with endothelial progenitor cells (EPCs), glyco-metabolic control and serum levels of advanced glycation endproducts (AGEs), soluble receptors for AGEs (sRAGE) and adiponectin were evaluated.
Sixteen uncomplicated young T1DM patients (mean age 18 ± 2 years, history of disease 11 ± 5 years, HbA1c 7.7 ± 1.1%) and 26 controls (mean age 19 ± 2 years) were studied. A radiofrequency-based ultrasound system (Esaote MyLab 70) was used to measure carotid IMT and wave speed (WS, index of local stiffness), applanation tonometry (PulsePen) was applied to obtain central pulse pressure (PP) and augmentation index (AIx), and carotid-femoral pulse wave velocity (PWV, Complior) was used as index of aortic stiffness. Peripheral endothelium-dependent vasodilation was determined as reactive hyperemia index (RHI, EndoPAT). Circulating EPCs, glycometabolic profile, AGEs (autofluorescence method), sRAGE and adiponectin were also measured.
After adjusting for age, sex and blood pressure, T1DM adolescents had significantly higher carotid IMT (456 ± 7 vs. 395 ± 63 μm, p < 0.005), carotid WS (p < 0.005), PWV (p = 0.01), AIx (p < 0.0001) and central PP (p < 0.01) and lower EPCs (p = 0.02) as compared to controls. RHI was reduced only in diabetic patients with HbA1c ≥7.5% (p < 0.05). In the overall population, EPCs were an independent determinant of carotid IMT (together with adiponectin), while fasting plasma glucose was an independent determinant of carotid WS, AIx and central PP.
Our findings suggest that young subjects with relatively long-lasting T1DM have a generalized preclinical involvement of large artery structure and function, as well as a blunted endothelium regenerating capacity. Hyperglycemia and suboptimal chronic glycemic control seem to deteriorate the functional arterial characteristics, such as large arteries stiffness, wave reflection and peripheral endothelium-dependent vasodilation, whereas an impaired endothelium regenerating capacity and adiponectin levels seem to influence arterial structure.
颈动脉内膜中层厚度（IMT）、大动脉僵硬度指数和内皮功能测量值可作为 1 型糖尿病（T1DM）患者早期动脉粥样硬化的标志物。本研究旨在比较青少年 T1DM 患者与同龄健康对照组之间的大动脉结构和功能以及内皮功能和再生能力。此外，还评估了不同血管测量值与内皮祖细胞（EPCs）、糖代谢控制以及晚期糖基化终产物（AGEs）、可溶性 AGEs 受体（sRAGE）和脂联素的相关性。
研究了 16 例未经治疗的年轻 T1DM 患者（平均年龄 18 ± 2 岁，患病时间 11 ± 5 年，HbA1c 7.7 ± 1.1%）和 26 例对照组（平均年龄 19 ± 2 岁）。使用基于射频的超声系统（Esaote MyLab 70）测量颈动脉 IMT 和波速（WS，局部僵硬度指数），应用平板张力计（PulsePen）获得中心脉搏压（PP）和增强指数（AIx），使用颈动脉-股动脉脉搏波速度（PWV，Complior）作为主动脉僵硬度的指标。外周内皮依赖性血管舒张作为反应性充血指数（RHI，EndoPAT）进行测定。还测量了循环 EPCs、糖代谢谱、AGEs（自体荧光法）、sRAGE 和脂联素。
在调整年龄、性别和血压后，T1DM 青少年的颈动脉 IMT（456 ± 7 与 395 ± 63 μm，p < 0.005）、颈动脉 WS（p < 0.005）、PWV（p = 0.01）、AIx（p < 0.0001）和中心 PP（p < 0.01）显著更高，而 EPCs 更低（p = 0.02）。仅在 HbA1c≥7.5%的糖尿病患者中 RHI 降低（p < 0.05）。在总体人群中，EPCs 是颈动脉 IMT 的独立决定因素（与脂联素一起），而空腹血糖是颈动脉 WS、AIx 和中心 PP 的独立决定因素。
我们的发现表明，患有相对较长时间 T1DM 的年轻患者大动脉结构和功能存在广泛的亚临床受累，以及内皮再生能力受损。高血糖和不理想的慢性血糖控制似乎会使动脉功能特征恶化，如大动脉僵硬度、波反射和外周内皮依赖性血管舒张，而受损的内皮再生能力和脂联素水平似乎会影响动脉结构。
