Department of Internal Medicine, Koshigaya Hospital, Dokkyo Medical University, 2-1-50 Minami-Koshigaya, Saitama, Japan.
Diabet Med. 2012 Jan;29(1):80-7. doi: 10.1111/j.1464-5491.2011.03364.x.
Orthostatic hypotension is a hallmark of diabetic autonomic neuropathy and is associated with increased mortality. The serum level of adiponectin is elevated in patients with heart failure or renal failure. In the present study, we measured serum levels of total and high molecular weight adiponectin in patients with Type 2 diabetes and orthostatic hypotension. We also investigated the relationship between the presence of orthostatic hypotension and various clinical variables in patients with Type 2 diabetes.
We studied 105 patients with Type 2 diabetes. Orthostatic hypotension was defined as a decrease of 20 mmHg or more in systolic blood pressure and/or 10 mmHg in diastolic blood pressure when blood pressure was measured for 3 min while standing. The brachial-ankle pulse-wave velocity was also measured as an index of arterial stiffness.
Orthostatic hypotension was found in 30 patients with diabetes (28.6%). The haematocrit and estimated glomerular filtration rate were significantly lower in patients with orthostatic hypotension than in those without it. Brachial-ankle pulse-wave velocity and serum total and high molecular weight adiponectin were significantly higher in patients with orthostatic hypotension than in those without. Furthermore, the high molecular weight/total adiponectin ratio was higher in patients with orthostatic hypotension than in those without and hypertension was more common in patients with orthostatic hypotension. Plasma prothrombin F1 + 2, a coagulation maker, was higher in patients with orthostatic hypotension than in those without, while there were no differences of fibrinolytic markers between the two groups. Multivariate analysis showed that HDL cholesterol, haematocrit, F1 + 2, brachial-ankle pulse-wave velocity and a decline of systolic blood pressure on standing were independent determinants of high molecular weight adiponectin.
Patients with Type 2 diabetes and orthostatic hypotension had an elevated serum level of high molecular weight adiponectin, which was associated with the simultaneous presence of renal dysfunction, anaemia, arterial stiffness and hypercoagulability.
直立性低血压是糖尿病自主神经病变的标志，与死亡率升高有关。在心力衰竭或肾衰竭患者中，脂联素的血清水平升高。在本研究中，我们测量了 2 型糖尿病伴直立性低血压患者的总和高分子量脂联素的血清水平。我们还研究了 2 型糖尿病患者中直立性低血压的存在与各种临床变量之间的关系。
我们研究了 105 例 2 型糖尿病患者。直立性低血压定义为当血压在站立 3 分钟时测量时收缩压下降 20mmHg 或更多和/或舒张压下降 10mmHg。还测量了肱踝脉搏波速度作为动脉僵硬的指标。
在 30 例糖尿病患者（28.6%）中发现直立性低血压。与无直立性低血压的患者相比，有直立性低血压的患者的血细胞比容和估计肾小球滤过率明显降低。肱踝脉搏波速度以及血清总和高分子量脂联素在有直立性低血压的患者中明显高于无直立性低血压的患者。此外，有直立性低血压的患者的高分子量/总脂联素比值高于无直立性低血压的患者，并且有直立性低血压的患者更常见高血压。与无直立性低血压的患者相比，有直立性低血压的患者的凝血酶原 F1 + 2 更高，而两组之间的纤维蛋白溶解标志物没有差异。多变量分析表明，高密度脂蛋白胆固醇、血细胞比容、F1 + 2、肱踝脉搏波速度和站立时收缩压下降是高分子量脂联素的独立决定因素。
2 型糖尿病伴直立性低血压患者的血清高分子量脂联素水平升高，这与肾功能不全、贫血、动脉僵硬和高凝状态同时存在有关。
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