Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Ann Thorac Surg. 2014 Mar;97(3):851-7. doi: 10.1016/j.athoracsur.2013.09.102. Epub 2013 Dec 4.
Diabetes is a well- identified major risk factor for cardiovascular diseases. This study was performed to evaluate the effect of diabetes and impact of glycemic control on internal thoracic artery (ITA) morphology by electron microscopy.
Thirty patients scheduled for coronary artery bypass grafting were enrolled in this study. Samples of ITA were taken during the surgery for electron microscopic evaluation. Group I (n = 10) consisted of diabetics who have poor glycemic control (HbA1c > 7.5%), group II (n = 10) of well-regulated (HbA1c = 4.4% to 6.2%) diabetic patients, and group III (n = 10) of nondiabetic patients. Samples were prepared as ultrathin sections and an original semiquantitative method of scoring was applied to describe the morphologic changes of endothelium. Final scores were analyzed with analysis of variance and post hoc analysis.
In group I large vacuoles, swollen mitochondria were seen in endothelial cells and subendothelial edema was prominent. Endothelia (2.5 ± 1.2), arterial wall (2.0 ± 0.0), and endothelial mitochondria (2.9 ± 1.3) scores of group I were significantly higher than the other 2 groups (p < 0.001). The samples of group II and group III did not show significant differences with each other. The correlation between HbA1c values and total endothelial scores statistically significant (r = 0.912; p < 0.001).
There is a correlation between HbA1c values and morphologic changes of ITA graft. Uncontrolled diabetes is an important predictor of morphologic changes evidenced by the ultrastructural findings. These ultrastructural changes were not as prominent in the diabetes mellitus patients with well controlled metabolic statuses and patients without diabetes.
糖尿病是心血管疾病的一个明确的主要危险因素。本研究旨在通过电子显微镜评估糖尿病对胸廓内动脉（ITA）形态的影响以及血糖控制的影响。
本研究纳入了 30 名计划行冠状动脉旁路移植术的患者。在手术过程中采集 ITA 样本进行电子显微镜评估。组 I（n=10）包括血糖控制不佳（HbA1c>7.5%）的糖尿病患者，组 II（n=10）包括血糖控制良好（HbA1c=4.4%至 6.2%）的糖尿病患者，组 III（n=10）为非糖尿病患者。样本制备为超薄切片，并应用原始半定量评分方法描述内皮细胞的形态变化。采用方差分析和事后分析对最终评分进行分析。
组 I 中可见内皮细胞内大空泡、肿胀的线粒体和明显的内膜下水肿。组 I 的内皮（2.5±1.2）、动脉壁（2.0±0.0）和内皮线粒体（2.9±1.3）评分明显高于其他 2 组（p<0.001）。组 II 和组 III 的样本之间无显著差异。HbA1c 值与总内皮评分之间存在相关性（r=0.912；p<0.001）。
HbA1c 值与 ITA 移植物的形态变化之间存在相关性。未控制的糖尿病是形态学变化的重要预测因素，这些超微结构变化在代谢状态得到良好控制的糖尿病患者和无糖尿病患者中并不明显。
