Jojima Teruo, Kurai Hidetaka, Tanuma Dai, Kajitani Hayato, Kase Masato, Inoue Yuiko, Sakurai Shintaro, Iijima Toshie, Tomaru Takuya, Usui Isao, Aso Yoshimasa
Department of Endocrinology and Metabolism, Dokkyo Medical University, Mibu, Tochigi, Japan.
Int J Cardiol Heart Vasc. 2022 Jun 16;41:101071. doi: 10.1016/j.ijcha.2022.101071. eCollection 2022 Aug.
To investigate synergistic effects of liver fibrosis evaluated by FibroScan and sarcopenia on endothelial function and arterial stiffness in patients with type 2 diabetes.
This cross-sectional study evaluated liver fibrosis (LF) and sarcopenia in 115 patients with type 2 diabetes. LF was assessed as the liver stiffness measurement (LSM) in transient elastography (FibroScan) and was defined as an LSM greater than or equal to 8.0 kPa. Sarcopenia was defined as a ratio of appendicula skeletal muscle mass to body mass index of<0.789 in men and<0.512 in women. Endothelial function was measured by reactive hyperemia index (RHI) with tonometry, and arterial stiffness was evaluated by the cardio-ankle vascular index (CAVI). Endothelial dysfunction was defined an RHI value below 1.67, while arterial stiffness was defined a CAVI value above 9.0. Patients were divided into four groups: no LF and no sarcopenia; LF but no sarcopenia; no LF but sarcopenia; and LF and sarcopenia. The composite of endothelial dysfunction of arterial stiffness was defined as an outcome.
In patients with LF, RHI was significantly lower and CAVI was significantly higher than in patients without LF. Furthermore, RHI was significantly lower in patients with sarcopenia than in those without it. Patients with both LF and sarcopenia had the lowest RHI and the highest CAVI and urinary albumin levels. Sarcopenia and HDL cholesterol were independent factor the composite of endothelial dysfunction and arterial stiffness.
LF and sarcopenia are independently associated with endothelial dysfunction and arterial stiffness in patients with type 2 diabetes. Coexistence of LF and sarcopenia may synergistically lead to vascular damage and thus contribute to the high risk of cardiovascular disease in people with type 2 diabetes.
探讨通过FibroScan评估的肝纤维化和肌肉减少症对2型糖尿病患者内皮功能和动脉僵硬度的协同作用。
这项横断面研究评估了115例2型糖尿病患者的肝纤维化（LF）和肌肉减少症。LF通过瞬时弹性成像（FibroScan）中的肝脏硬度测量（LSM）进行评估，定义为LSM大于或等于8.0 kPa。肌肉减少症定义为男性阑尾骨骼肌质量与体重指数之比<0.789，女性<0.512。通过使用眼压计的反应性充血指数（RHI）测量内皮功能，并通过心踝血管指数（CAVI）评估动脉僵硬度。内皮功能障碍定义为RHI值低于1.67，而动脉僵硬度定义为CAVI值高于9.0。患者分为四组：无LF且无肌肉减少症；有LF但无肌肉减少症；无LF但有肌肉减少症；有LF且有肌肉减少症。将内皮功能障碍和动脉僵硬度的综合情况定义为一个结果。
与无LF的患者相比，有LF的患者RHI显著降低，CAVI显著升高。此外，有肌肉减少症的患者RHI显著低于无肌肉减少症的患者。同时患有LF和肌肉减少症的患者RHI最低，CAVI和尿白蛋白水平最高。肌肉减少症和高密度脂蛋白胆固醇是内皮功能障碍和动脉僵硬度综合情况的独立因素。
LF和肌肉减少症分别与2型糖尿病患者的内皮功能障碍和动脉僵硬度相关。LF和肌肉减少症并存可能协同导致血管损伤，从而促使2型糖尿病患者发生心血管疾病的风险升高。
