Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, 1 place du Parvis Notre Dame, 75004 Paris, France; Department of Internal Medicine, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
Atherosclerosis. 2013 Oct;230(2):315-21. doi: 10.1016/j.atherosclerosis.2013.07.054. Epub 2013 Aug 9.
Arterial stiffness in hypertension is markedly influenced by age, mean arterial pressure (MAP) and heart rate, whereas factors influencing this parameter in diabetes mellitus are not yet fully understood. The aim of our study was to compare central hemodynamics in diabetics (n = 126) versus non-diabetic controls (n = 203), most of whom were hypertensive, and with similar MAP. Anthropometric, laboratory and clinical measurements were collected. Hemodynamic parameters (central blood pressure, aortic pulse wave velocity [PWV], augmentation index [AIx] and pulse pressure amplification [PPA]) were measured using applanation tonometry. PWV and AIx were significantly higher in diabetics, after adjustment for age, gender, MAP, and heart rate. After further adjustment for metabolic syndrome, only the difference in PWV persisted (P < 0.0001). PPA was marginally altered though not significantly. In diabetics, PWV did not correlate with MAP, suggesting that other structural alterations, resulting from insulin resistance, may account for diabetic arterial stiffening to a greater extent than, and independently of, blood pressure. Chronic treatment with insulin was associated with increased PWV, independently of blood pressure, diabetes control and duration, or other common confounding variables. In conclusion, hypertensive diabetics had greater arterial stiffness than hypertensive controls. In diabetes, multiple factors affect arterial stiffening independently of hemodynamic status. Notably, insulin therapy (IT) is associated with more severe arterial stiffness, suggesting a consistent relationship between these parameters. It remains to be determined whether IT should be considered as a marker of diabetes severity that leads to increased arterial stiffness, or whether it has a direct/indirect effect on arterial wall modifications.
高血压患者的动脉僵硬度明显受年龄、平均动脉压 (MAP) 和心率的影响，而影响糖尿病患者这一参数的因素尚不完全清楚。我们的研究目的是比较糖尿病患者 (n=126)与非糖尿病对照组 (n=203) 的中心血流动力学，其中大多数患者患有高血压且 MAP 相似。收集了人体测量、实验室和临床测量数据。使用平板测压法测量血流动力学参数 (中心血压、主动脉脉搏波速度 [PWV]、增强指数 [AIx] 和脉搏压力放大率 [PPA])。在校正年龄、性别、MAP 和心率后，糖尿病患者的 PWV 和 AIx 显著升高。进一步调整代谢综合征后，仅 PWV 的差异持续存在 (P<0.0001)。尽管 PPA 略有改变，但没有显著差异。在糖尿病患者中，PWV 与 MAP 不相关，表明其他结构改变，可能与胰岛素抵抗有关，导致动脉僵硬的程度大于、独立于血压。慢性胰岛素治疗与 PWV 增加独立相关，与血压、糖尿病控制和持续时间或其他常见混杂因素无关。总之，高血压糖尿病患者的动脉僵硬度大于高血压对照组。在糖尿病中，多种因素独立于血流动力学状态影响动脉僵硬。值得注意的是，胰岛素治疗 (IT) 与更严重的动脉僵硬相关，表明这些参数之间存在一致的关系。目前尚不清楚 IT 是否应被视为导致动脉僵硬增加的糖尿病严重程度的标志物，还是其对动脉壁改变有直接/间接影响。
