Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France.
Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France.
Front Endocrinol (Lausanne). 2020 Apr 17;11:203. doi: 10.3389/fendo.2020.00203. eCollection 2020.
A large yet heterogeneous body of literature exists suggesting that endothelial dysfunction appears early in type 1 diabetes, due to hyperglycemia-induced oxidative stress. The latter may also affect vascular smooth muscles (VSM) function, a layer albeit less frequently considered in that pathology. This meta-analysis aims at evaluating the extent, and the contributing risk factors, of early endothelial dysfunction, and of the possible concomitant VSM dysfunction, in type 1 diabetes. PubMed, Web of Sciences, Cochrane Library databases were screened from their respective inceptions until October 2019. We included studies comparing vasodilatory capacity depending or not on endothelium (i.e., endothelial function or VSM function, respectively) in patients with uncomplicated type 1 diabetes and healthy controls. Fifty-eight articles studying endothelium-dependent function, among which 21 studies also assessed VSM, were included. Global analyses revealed an impairment of standardized mean difference (SMD) (Cohen's d) of endothelial function: -0.61 (95% CI: -0.79, -0.44) but also of VSM SMD: -0.32 (95% CI: -0.57, -0.07). The type of stimuli used (i.e., exercise, occlusion-reperfusion, pharmacological substances, heat) did not influence the impairment of the vasodilatory capacity. Endothelial dysfunction appeared more pronounced within macrovascular than microvascular beds. The latter was particularly altered in cases of poor glycemic control [HbA > 67 mmol/mol (8.3%)]. This meta-analysis not only corroborates the presence of an early impairment of endothelial function, even in response to physiological stimuli like exercise, but also highlights a VSM dysfunction in children and adults with type 1 diabetes. Endothelial dysfunction seems to be more pronounced in large than small vessels, fostering the debate on their relative temporal appearance.
大量且不同的文献表明，1 型糖尿病患者存在内皮功能障碍，这是由于高血糖引起的氧化应激。后者也可能影响血管平滑肌（VSM）功能，尽管在该病理中较少考虑这一层。这项荟萃分析旨在评估 1 型糖尿病中内皮功能早期障碍的程度和可能的相关血管平滑肌功能障碍的程度及其相关的危险因素。从各自的开始时间到 2019 年 10 月，我们筛选了 PubMed、Web of Sciences、Cochrane Library 数据库。我们纳入了比较伴有或不伴有内皮舒张功能（即内皮功能或 VSM 功能）的未合并 1 型糖尿病患者和健康对照者的血管舒张能力的研究。共有 58 篇研究了内皮依赖性功能，其中 21 篇研究还评估了 VSM。总体分析显示，内皮功能的标准化均数差（SMD）（Cohen's d）受损：-0.61（95%CI：-0.79，-0.44），VSM 的 SMD 也受损：-0.32（95%CI：-0.57，-0.07）。所使用的刺激类型（即运动、闭塞-再灌注、药物物质、热）并不影响血管舒张能力的损伤。内皮功能障碍在大血管床中比微血管床中更为明显。在血糖控制不佳的情况下（HbA>67mmol/mol（8.3%）），后者尤其改变。这项荟萃分析不仅证实了即使在运动等生理刺激下，内皮功能也存在早期损伤，而且还强调了 1 型糖尿病儿童和成人中存在血管平滑肌功能障碍。内皮功能障碍在大血管中比在小血管中更为明显，这促进了关于它们相对出现时间的争论。
