Danilogorskaya Yu A, Zheleznykh E A, Privalova E A, Belenkov Yu N, Shchendrigina A A, Kozhevnikova M V, Shakaryants G A, Zektser V Yu, Lishuta A S, Khabarova N V
I.M. Sechenov First Moscow State Medical University, Department of Hospital Therapy #1.
Kardiologiia. 2020 Feb 4;60(1):4-9. doi: 10.18087/cardio.2020.1.n888.
Objective Investigate the dynamics of morphological and functional markers of vascular remodeling in patients with arterial hypertension (AH), including those with concomitant type 2 diabetes mellitus (DM2), during 12-month administration of perindopril A.Material and Methods The study included patients with grade I-II AH, with and without DM2 (30 and 32 patients, respectively), who underwent outpatient correction of initially ineffective antihypertensive therapy and administration of perindopril A, 10 mg/day. Morphological and functional parameters of vascular remodeling were evaluated in all patients at baseline and at 12 months using photoplethysmography. Stiffness index (SI) and phase shift (PS) were measured in large vessels. Reflection index (RI) and occlusion index (OI) were measured in microvessels. Computed nailfold videocapillaroscopy was used to determine capillary density (CD) at rest (CDr), CD during venous occlusion test (CDvo), and CD during reactive hyperemia test (CDrh). Data are medians [interquartile range].Results After 12-month administration of perindopril A, the morphological and functional parameters of vascular remodeling in AH patients without DM2 significantly improved at all vascular levels. SI decreased to 9.25 [7.8; 10.93 ] m/s and PS increased to 7.4 [5.6; 9.05] ms. In microvasculature, a statistically significant reduction was observed in RI, 31 [27; 36.5]%, and an increase was observed in OI, which characterizes endothelium function, 1.75 [1.68; 1.9]. Capillary CDr significantly increased to 40.5 [34.93; 46] cap/mm2, as did CDvo and CDrh. At the same time, in the group of patients with AH and DM2, a significant improvement was observed for the large vessels. SI decreased to 9.8 [9.08; 10.58] m/s, and PS increased to 6.95 [5.13; 10.08]. The RI index, reflecting the structural condition of arterioles, significantly decreased to 34 [25.9; 45.53]%, and the OI index, characterizing endothelial function, did not change significantly, 1.4 [1.3; 1.6]. Capillary CDr significantly increased to 31.55 [27.68; 34.7 ] cap/mm2; however, CDvo and CDrh did not change significantly. Renal function improved in both groups.Conclusion Both groups demonstrated improvement of morphological parameters at all levels of the arterial bed. However, patients with AH and concomitant DM2 showed no improvement of the endothelial function of arterioles and capillaries compared to improvement in AH patients without DM2. This reflected the more severe endothelial dysfunction present in AH patients with DM2.
目的 研究培哚普利A治疗12个月期间，动脉高血压（AH）患者（包括合并2型糖尿病（DM2）的患者）血管重塑的形态学和功能标志物的动态变化。
材料与方法 本研究纳入了I-II级AH患者，分为合并DM2组和未合并DM2组（分别为30例和32例），这些患者门诊接受了最初无效的降压治疗并给予培哚普利A，剂量为10 mg/天。在基线和12个月时，使用光电容积描记法对所有患者血管重塑的形态学和功能参数进行评估。在大血管中测量僵硬度指数（SI）和相移（PS）。在微血管中测量反射指数（RI）和闭塞指数（OI）。采用计算机化甲襞视频毛细血管镜检查法测定静息时的毛细血管密度（CDr）、静脉闭塞试验期间的CD（CDvo）和反应性充血试验期间的CD（CDrh）。数据为中位数[四分位间距]。
结果 培哚普利A治疗12个月后，未合并DM2的AH患者在所有血管水平上血管重塑的形态学和功能参数均显著改善。SI降至9.25[7.8；10.93]m/s，PS升至7.4[5.6；9.05]ms。在微血管中，RI有统计学意义地降低，为31[27；36.5]%，而表征内皮功能的OI升高，为1.75[1.68；1.9]。毛细血管CDr显著升至40.5[34.93；46]根/mm²，CDvo和CDrh也如此。同时，在AH合并DM2组患者中，大血管有显著改善。SI降至9.8[9.08；10.58]m/s，PS升至6.95[5.13；10.08]。反映小动脉结构状况的RI指数显著降至34[25.9；45.53]%，而表征内皮功能的OI指数无显著变化，为1.4[1.3；1.6]。毛细血管CDr显著升至31.55[27.68；34.7]根/mm²；然而，CDvo和CDrh无显著变化。两组患者的肾功能均有所改善。
结论 两组患者在动脉床的所有水平上形态学参数均有改善。然而，与未合并DM2的AH患者相比，AH合并DM2的患者小动脉和毛细血管的内皮功能未得到改善。这反映出AH合并DM2患者存在更严重的内皮功能障碍。
