Department of Rehabilitation Medicine, Taipei City Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Lasers Med Sci. 2023 Feb 28;38(1):80. doi: 10.1007/s10103-023-03737-x.
Microangiopathy should be noted in diabetes with subclinical vascular diseases. Little is known about whether various surrogate markers of systemic arterial trees exacerbate simultaneously in preclinical atherosclerosis. To clarify the association of skin microvascular reactivity with arterial stiffness is essential to elucidating early atherosclerotic changes. The post-occlusive reactive hyperemia of skin microcirculation was evaluated in 27 control and 65 type 2 diabetic subjects, including 31 microalbuminuria (MAU) and 34 normoalbuminuria (NAU) patients. The laser Doppler skin perfusion signals were transformed into three frequency intervals for the investigation of endothelial, neurogenic, and myogenic effects on basal and reactive flow motion changes. The analysis of spectral intensity and distribution provided insight into potential significance of microvascular regulation in subclinical atherosclerotic diseases. Systemic arterial stiffness was studied by the brachial ankle pulse wave velocity (baPWV). Following occlusive ischemia, the percent change of endothelial flow motion was lower in MAU than in NAU and control groups. The MAU group revealed a relative increase in myogenic activity and a decrease in endothelial activity in normalized spectra. The baPWV showed more significant associations with reactive endothelial change (r = - 0.48, P < 0.01) and normalized myogenic value (r = - 0.37, P < 0.05) than diabetes duration and HbA1c. By multivariate regression analysis, only endothelial vasomotor changes independently contributed to the decreased baPWV (OR 3.47, 95% CI 1.63-7.42, P < 0.05). Impaired microcirculatory control is associated with increased arterial stiffness in preclinical atherosclerosis. To identify the early manifestations is necessary for at-risk patients to prevent from further vascular damage.
糖尿病患者存在亚临床血管疾病时应注意微血管病变。目前尚不清楚各种系统性动脉树的替代标志物是否会同时在临床前动脉粥样硬化中加重。阐明皮肤微血管反应性与动脉僵硬度的关系对于阐明早期动脉粥样硬化变化至关重要。在 27 名对照和 65 名 2 型糖尿病患者中评估了皮肤微循环的闭塞后反应性充血，包括 31 名微量白蛋白尿（MAU）和 34 名正常白蛋白尿（NAU）患者。将激光多普勒皮肤灌注信号转换为三个频率间隔，以研究内皮、神经源性和肌源性对基础和反应性血流运动变化的影响。光谱强度和分布的分析为亚临床动脉粥样硬化疾病中小血管调节的潜在意义提供了深入了解。通过肱踝脉搏波速度（baPWV）研究系统动脉僵硬度。闭塞性缺血后，MAU 组内皮血流运动的百分比变化低于 NAU 组和对照组。MAU 组在归一化光谱中显示出相对增加的肌源性活性和降低的内皮活性。baPWV 与反应性内皮变化（r=-0.48，P<0.01）和归一化肌源性值（r=-0.37，P<0.05）的相关性均大于糖尿病病程和 HbA1c。通过多元回归分析，只有内皮血管舒缩变化独立导致 baPWV 降低（OR 3.47，95%CI 1.63-7.42，P<0.05）。微血管控制受损与临床前动脉粥样硬化中动脉僵硬度增加有关。识别早期表现对于高危患者预防进一步的血管损伤是必要的。
