Kuryliszyn-Moskal Anna, Zarzycki Wieslaw, Dubicki Artur, Moskal Diana, Kosztyła-Hojna Bozena, Hryniewicz Anna
Department of Rehabilitation, Medical University of Bialystok, Poland.
Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Poland.
Adv Med Sci. 2017 Sep;62(2):368-373. doi: 10.1016/j.advms.2016.11.007. Epub 2017 May 23.
Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of our study was to compare microvascular changes examined by nailfold videocapillaroscopy (NVC) examination with serum concentrations of vascular endothelial growth factor (VEGF), soluble thrombomodulin (sTM) and endothelin-1 (ET-1) in people with Type 1 diabetes with and without microangiopathy.
MATERIAL/METHODS: The study included 106 people with Type 1 diabetes and 40 healthy controls. All participants were evaluated by extensive clinical, laboratory and capillaroscopic studies. NVC was performed using a stereomicroscope SZ 4045 (Olympus, Germany). The intensity of morphological changes was graded from 0 to 3. Serum levels of VEGF, sTM and ET-1 were determined by an enzyme-linked immunosorbent assay (ELISA).
Morphological changes were observed by NVC in 86 out of 106 (81%) people with Type 1 diabetes mellitus. Severe capillaroscopic changes (score 3) were seen in 32 out of 54 (59%) people with microangiopathy, but in only seven out of 52 (13%) individuals without microangiopathy. Higher serum concentration of VEGF (p<0.001), ET-1 (p<0.001) and sTM (p<0.05) were demonstrated in people with diabetes complicated with microangiopathy compared to healthy controls. Moreover, comparison between people with and without microangiopathic complications showed a significantly higher capillaroscopic score and sTM serum concentration in the group with retinopathy (p<0.001) nephropathy (p<0.001) and neuropathy (p<0.01).
Our results suggest that abnormalities in NVC may reflect the extent of microvascular involvement and associated with higher VEGF, sTM and ET-1 serum levels, as well as with microangiopathic complications in diabetic people.
微血管异常是持续性糖尿病并发症的最重要原因之一。我们研究的目的是比较通过甲襞微血管镜检查（NVC）所检测到的微血管变化与1型糖尿病伴或不伴微血管病变患者血清中血管内皮生长因子（VEGF）、可溶性血栓调节蛋白（sTM）和内皮素-1（ET-1）的浓度。
材料/方法：该研究纳入了106例1型糖尿病患者和40例健康对照者。所有参与者均通过广泛的临床、实验室和微血管镜检查进行评估。使用SZ 4045体视显微镜（德国奥林巴斯公司）进行NVC检查。形态学变化强度从0到3进行分级。通过酶联免疫吸附测定（ELISA）测定血清VEGF、sTM和ET-1水平。
106例1型糖尿病患者中有86例（81%）通过NVC观察到形态学变化。54例微血管病变患者中有32例（59%）出现严重微血管镜改变（评分3），但在52例无微血管病变的个体中仅有7例（13%）出现。与健康对照相比，糖尿病合并微血管病变患者的血清VEGF（p<0.001）、ET-1（p<0.001）和sTM（p<0.05）浓度更高。此外，有微血管病变并发症和无并发症患者之间的比较显示，视网膜病变组（p<0.001）、肾病组（p<0.001）和神经病变组（p<0.01）的微血管镜评分和sTM血清浓度显著更高。
我们的结果表明，NVC异常可能反映微血管受累程度，并与糖尿病患者较高的VEGF、sTM和ET-1血清水平以及微血管病变并发症相关。
