高血糖对糖尿病猪模型和人类心肌灌注的影响。

Effect of Hyperglycemia on Myocardial Perfusion in Diabetic Porcine Models and Humans.

机构信息

Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.

Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.

出版信息

J Korean Med Sci. 2019 Jul 29;34(29):e202. doi: 10.3346/jkms.2019.34.e202.

BACKGROUND

Diabetes mellitus (DM) causes macro- and microvasculopathy, but data on cardiac microvascular changes in large animals are scarce. We sought to determine the effect of DM on macro- and microvascular changes in diabetic pigs and humans.

METHODS

Eight domestic pigs (4 with type I diabetes and 4 controls) underwent coronary angiography with optical coherence tomography (OCT; at baseline and 1 and 2 months), coronary computed tomography angiography, cardiac magnet resonance (CMR) imaging, and histologic examination.

RESULTS

The diabetic pigs had more irregular capillaries with acellular capillaries and a smaller capillary diameter (11.7 ± 0.33 μm vs. 13.5 ± 0.53 μm; < 0.001) than those of the control pigs. The OCT showed no significant epicardial stenosis in either group; however diabetic pigs had a greater intima-media thickness. CMR results showed that diabetic pigs had a lower relative upslope at rest (31.3 ± 5.9 vs. 37.9 ± 8.1; = 0.011) and during stress (18.0 ± 3.0 vs. 21.6 ± 2.8; = 0.007) than the control pigs, implying decreased myocardial perfusion. Among the 79 patients with ST elevation myocardial infarction, 25 had diabetes and they had lower myocardial perfusion on CMR as well.

CONCLUSION

DM causes microvascular remodeling and a decrease in myocardial perfusion in large animals at a very early stage of the disease course. Early and effective interventions are necessary to interrupt the progression of vascular complications in diabetic patients.

背景

糖尿病（DM）可导致大血管和微血管病变，但关于大型动物心脏微血管变化的数据却很少。我们试图确定糖尿病对糖尿病猪和人类的大血管和微血管变化的影响。

方法

8 头家猪（4 头患有 1 型糖尿病，4 头为对照）接受了冠状动脉造影术（使用光学相干断层扫描（OCT）；在基线和 1 个月及 2 个月时进行）、冠状动脉计算机断层血管造影术、心脏磁共振（CMR）成像和组织学检查。

结果

与对照组相比，糖尿病猪的毛细血管更不规则，有细胞外毛细血管，毛细血管直径更小（11.7 ± 0.33 μm 比 13.5 ± 0.53 μm；<0.001）。OCT 显示两组均无明显的外膜狭窄，但糖尿病猪的内膜-中膜厚度更大。CMR 结果显示，与对照组相比，糖尿病猪的静息时相对上升斜率较低（31.3 ± 5.9 比 37.9 ± 8.1；= 0.011），应激时较低（18.0 ± 3.0 比 21.6 ± 2.8；= 0.007），提示心肌灌注减少。在 79 例 ST 段抬高型心肌梗死患者中，有 25 例患有糖尿病，他们的 CMR 也显示心肌灌注较低。